Provider Demographics
NPI:1619170321
Name:BOCKHORST, BETTY ANN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:ANN
Last Name:BOCKHORST
Suffix:
Gender:F
Credentials:MA, 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 211
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-0211
Mailing Address - Country:US
Mailing Address - Phone:636-462-2005
Mailing Address - Fax:636-462-2005
Practice Address - Street 1:405 E CHERRY STREET
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379
Practice Address - Country:US
Practice Address - Phone:636-462-2005
Practice Address - Fax:636-462-2005
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007000038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional