Provider Demographics
NPI:1558896506
Name:TOCK, NICHOLAS (LCSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:TOCK
Suffix:
Gender:M
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:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-0900
Mailing Address - Country:US
Mailing Address - Phone:208-922-9001
Mailing Address - Fax:208-922-3778
Practice Address - Street 1:2061 S TOLUKA WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-8568
Practice Address - Country:US
Practice Address - Phone:208-590-3703
Practice Address - Fax:208-922-3778
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099282681041C0700X
MI68011174951041C0700X
IDLCSW-408311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical