Provider Demographics
NPI:1952017485
Name:BOCK, MICHAEL N
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
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 1:651 W MARION RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1027
Mailing Address - Country:US
Mailing Address - Phone:419-949-2000
Mailing Address - Fax:419-751-7322
Practice Address - Street 1:651 W MARION RD
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1027
Practice Address - Country:US
Practice Address - Phone:419-949-2000
Practice Address - Fax:419-751-7322
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC2304607TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor