MEDICARE: MS. WENDY SUE HENDERSON BULLOCK MA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2503	CO
2	101YP2500X	Professional Counselor	LPC2503	CO

General Provider Information

NPI Number	:	1275655961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WENDY SUE HENDERSON BULLOCK MA LPC

Provider Business Mailing Address
First Line	:	2250 S ONEIDA ST STE 200
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-2558
Country	:	US
Telephone Number	:	303-433-1975
Fax Number	:	303-433-1980

Provider Business Practice Location Address
First Line	:	13731 E RICE PL STE 105
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-1063
Country	:	US
Telephone Number	:	720-696-0268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	05/12/2021

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