MRS. Tracey La Dawn Bullock, RBT

NPI #1265948038 in Portales, New Mexico

Provider Information

NPI Number: 1265948038
Entity Type: Individual
Name: MRS. Tracey La Dawn Bullock, RBT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Credential: RBT
Enumeration Date: Dec 15, 2017
Last Updated: Dec 15, 2017

Practice Location

Address: 830 W 14TH ST
City: Portales
State: New Mexico
ZIP Code: 88130-6708
Phone: (575) 825-1229

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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