| Doctor Name: | MRS. GIZELLE MARIE BULLOCK |
| NPI Number: | 1710245758 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | 004799 |
| Business Practice Address: | 76 Lisbon St Heuvelton, NY - 136543130 |
| Business Phone Number: | 3152440244 |
| Business Fax Number: | 3152542811 |
| Mailing Address: | 76 Lisbon St, HEUVELTON |
| State: | NY |
| Postal Code: | 136543130 |
| Phone Number: | 3152440244 |
| Fax Number: | 3152542811 |
| NPI Enumeration Date: | 04/27/2012 |
| NPI Last Update Date: | 05/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 004799 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |