Provider Demographics
NPI:1578037024
Name:BULLOCK, NATALIE DANIELLE (LPC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:DANIELLE
Last Name:BULLOCK
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0792
Mailing Address - Country:US
Mailing Address - Phone:318-283-8887
Mailing Address - Fax:
Practice Address - Street 1:4787 HIGHWAY 151
Practice Address - Street 2:
Practice Address - City:DOWNSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71234-5145
Practice Address - Country:US
Practice Address - Phone:985-805-6068
Practice Address - Fax:504-930-4019
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7751101YP2500X, 101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1417252230Medicaid