Provider Demographics
NPI:1811430499
Name:BULLOCK, JEFF BLACK (LCDC)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:BLACK
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2600 AVENUE K STE 102
Mailing Address - Street 2:ACCESS COUNSELING GROUP
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074
Mailing Address - Country:US
Mailing Address - Phone:972-423-8727
Mailing Address - Fax:972-423-8918
Practice Address - Street 1:2600 AVENUE K STE 102
Practice Address - Street 2:ACCESS COUNSELING GROUP
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074
Practice Address - Country:US
Practice Address - Phone:972-423-8727
Practice Address - Fax:972-423-8918
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)