Provider Demographics
NPI:1982852216
Name:BOCK, MELODY LYNN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:LYNN
Last Name:BOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220D N. SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7465
Mailing Address - Country:US
Mailing Address - Phone:903-868-2961
Mailing Address - Fax:
Practice Address - Street 1:220D N. SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7465
Practice Address - Country:US
Practice Address - Phone:903-868-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61630101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor