Provider Demographics
NPI:1215215090
Name:BOCK, BERLYN MILLER (LCSW,ACP)
Entity Type:Individual
Prefix:MS
First Name:BERLYN
Middle Name:MILLER
Last Name:BOCK
Suffix:
Gender:F
Credentials:LCSW,ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 BELLAIRE DR S
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2025
Mailing Address - Country:US
Mailing Address - Phone:817-924-4270
Mailing Address - Fax:
Practice Address - Street 1:4101 BELLAIRE DR S
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-2025
Practice Address - Country:US
Practice Address - Phone:817-924-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16351041C0700X
TX106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist