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1902682016
WARREN KEITH BULLOCK
BASTROP, LA
NPI
1902682016
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: LA CIT-5695)
Enumeration Date
2023-09-05
Last Update Date
2023-09-05
Business Address
Mr. WARREN KEITH BULLOCK
343 N WASHINGTON ST
BASTROP, LA 71220-3849
Phone number: 318-974-5075
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Mailing Address
Mr. WARREN KEITH BULLOCK
1103 LAVENDER DR
WINNSBORO, LA 71295-4402
Phone number: 504-274-8007
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