Provider Demographics
NPI:1427207687
Name:MOCK, CORLISS HELEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:CORLISS
Middle Name:HELEN
Last Name:MOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 503010
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-0813
Mailing Address - Country:US
Mailing Address - Phone:541-941-7792
Mailing Address - Fax:503-419-4662
Practice Address - Street 1:2000 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7635
Practice Address - Country:US
Practice Address - Phone:719-650-1715
Practice Address - Fax:503-419-4662
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10164101YM0800X
ORC3213101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health