Provider Demographics
NPI:1942307525
Name:BOCKRATH, GLORIA (PHD COUNSELOR)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:BOCKRATH
Suffix:
Gender:F
Credentials:PHD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 MADEIRA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1213
Mailing Address - Country:US
Mailing Address - Phone:225-769-3512
Mailing Address - Fax:225-761-9210
Practice Address - Street 1:7920 WRENWOOD BLVD
Practice Address - Street 2:STE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1784
Practice Address - Country:US
Practice Address - Phone:225-927-2573
Practice Address - Fax:225-761-9210
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health