Provider Demographics
NPI:1831430628
Name:BOCOCK, AMANDA L (LMFT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:BOCOCK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 COURT AVE
Mailing Address - Street 2:SUITE 241
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2245
Mailing Address - Country:US
Mailing Address - Phone:515-875-4936
Mailing Address - Fax:515-875-4816
Practice Address - Street 1:309 COURT AVE
Practice Address - Street 2:SUITE 241
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2245
Practice Address - Country:US
Practice Address - Phone:515-875-4936
Practice Address - Fax:515-875-4816
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000396106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist