Mary Elizabeth Bullock-Rest, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY-95-14 Issued in AR

Practice address

130 E Poplar St
Fayetteville, AR 72703-2532

Phone

(479) 799-1806

NPI assigned

Mar 1, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ozark Guidance Center, Inc

  • Family Medicine Physician
  • Springdale, AR
  • NPI 1659945194
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411344000000",
    "number": "1417085689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 E POPLAR ST",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032532",
            "telephone_number": "479-799-1806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E POPLAR ST",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032532",
            "telephone_number": "479-799-1806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK-REST",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2014-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AR",
            "license": "95-14P",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AR",
            "license": "PSY-95-14",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Building Bridges Therapy Center
• Kamlesh V Bulchandani, MD
• Natalie Bules, RD, LD
• Kati L. Bullington, OT
• Brandon Scott Bulloch, DDS
• Kirstin Bump
• Cara L Burcham, OT
• Casey Ann Burd
• Margaret Adams Burge, B.S.,M.A.T., M.S.W
• Barrett Burger, MD

• Psychologist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Psychologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.