Provider Demographics
NPI:1710051768
Name:BOCH, ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:BOCH
Suffix:
Gender:F
Credentials:PHD
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 5124
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407-5124
Mailing Address - Country:US
Mailing Address - Phone:812-320-0544
Mailing Address - Fax:
Practice Address - Street 1:208 N WALNUT ST STE 203
Practice Address - Street 2:SUITE 203
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-4926
Practice Address - Country:US
Practice Address - Phone:812-320-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041250103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling