Provider Demographics
NPI:1184951394
Name:BOCK, JUDITH P (LPC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:P
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 1:1330 QUAIL LAKE LOOP
Mailing Address - Street 2:STE. 240
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4651
Mailing Address - Country:US
Mailing Address - Phone:719-640-5445
Mailing Address - Fax:719-355-1789
Practice Address - Street 1:1330 QUAIL LAKE LOOP
Practice Address - Street 2:STE. 240
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4651
Practice Address - Country:US
Practice Address - Phone:719-640-5445
Practice Address - Fax:719-355-1789
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5271OtherLICENSED PROFESSIONAL COUNSELOR