Provider Demographics
NPI:1013481621
Name:BOCK, GARRETT HARRY
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:HARRY
Last Name:BOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 CEDAR STREET
Mailing Address - Street 2:
Mailing Address - City:MANCELONA
Mailing Address - State:MI
Mailing Address - Zip Code:49659
Mailing Address - Country:US
Mailing Address - Phone:586-322-1720
Mailing Address - Fax:
Practice Address - Street 1:197 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:MANCELONA
Practice Address - State:MI
Practice Address - Zip Code:49659
Practice Address - Country:US
Practice Address - Phone:586-322-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician