Provider Demographics
NPI:1881183390
Name:BOCK, SUSAN CHRISTINE (LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:BOCK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 SUGAR BOTTOM RD NE
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-9589
Mailing Address - Country:US
Mailing Address - Phone:319-624-2301
Mailing Address - Fax:
Practice Address - Street 1:3726 QUEEN CT SW STE 103
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-3903
Practice Address - Country:US
Practice Address - Phone:319-560-0230
Practice Address - Fax:319-343-1059
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health