Provider Demographics
NPI:1356659007
Name:POCOCK, HEATHER L (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:POCOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 DIVIDEND DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3556
Mailing Address - Country:US
Mailing Address - Phone:208-359-9683
Mailing Address - Fax:208-359-9683
Practice Address - Street 1:218 DIVIDEND DR
Practice Address - Street 2:SUITE 3
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3556
Practice Address - Country:US
Practice Address - Phone:208-359-9683
Practice Address - Fax:208-359-9683
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-299191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical