Provider Demographics
NPI:1518013119
Name:BOCK, CINDY L (MA, LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:BOCK
Suffix:
Gender:F
Credentials:MA, LMHC, NCC
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:9760 N 68TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8813
Mailing Address - Country:US
Mailing Address - Phone:253-561-3531
Mailing Address - Fax:253-220-2531
Practice Address - Street 1:9760 N 68TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8813
Practice Address - Country:US
Practice Address - Phone:253-561-3531
Practice Address - Fax:253-220-2531
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011257101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2087357Medicaid