Provider Demographics
NPI:1588843577
Name:KATHARINE SCHROCK COUNSELING P.C.
Entity Type:Organization
Organization Name:KATHARINE SCHROCK COUNSELING P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:EVE
Authorized Official - Last Name:SCHROCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:574-536-0683
Mailing Address - Street 1:313 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-3709
Mailing Address - Country:US
Mailing Address - Phone:574-535-0880
Mailing Address - Fax:574-535-0882
Practice Address - Street 1:1930 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5907
Practice Address - Country:US
Practice Address - Phone:574-534-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004640A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN253860Medicare PIN