Provider Demographics
NPI:1225791536
Name:ALEX J. MOCK, LLC
Entity Type:Organization
Organization Name:ALEX J. MOCK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:216-505-1401
Mailing Address - Street 1:PO BOX 201544
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-8109
Mailing Address - Country:US
Mailing Address - Phone:216-505-1401
Mailing Address - Fax:
Practice Address - Street 1:3675 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-5078
Practice Address - Country:US
Practice Address - Phone:216-505-1401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty