Provider Demographics
NPI:1144075409
Name:BULLOCK, MARIAH (PHD)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:
Other - Last Name:NOGUEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7080 S 2985 E
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4254
Mailing Address - Country:US
Mailing Address - Phone:714-222-0002
Mailing Address - Fax:
Practice Address - Street 1:7080 S 2985 E
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-4254
Practice Address - Country:US
Practice Address - Phone:714-222-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist