Provider Demographics
NPI:1245065424
Name:BOCKEMEIER, PHILIP
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:BOCKEMEIER
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 1:915 BALAYE RIDGE CIR APT 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7667
Mailing Address - Country:US
Mailing Address - Phone:505-463-3145
Mailing Address - Fax:
Practice Address - Street 1:915 BALAYE RIDGE CIR APT 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7667
Practice Address - Country:US
Practice Address - Phone:505-463-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health