Provider Demographics
NPI:1598322422
Name:MOCKABEE GARDENER, INA RENEE
Entity Type:Individual
Prefix:MRS
First Name:INA
Middle Name:RENEE
Last Name:MOCKABEE GARDENER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24553 WHITE PINE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3000
Mailing Address - Country:US
Mailing Address - Phone:440-554-3365
Mailing Address - Fax:
Practice Address - Street 1:21843 NORTON RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-1252
Practice Address - Country:US
Practice Address - Phone:216-839-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-27
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1901765101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional