MEDICARE: JARED BOCKS BCABA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1528496114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED BOCKS BCABA

Provider Business Mailing Address
First Line	:	5309 WESTMINSTER CT S
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4825
Country	:	US
Telephone Number	:	817-781-8483
Fax Number	:

Provider Business Practice Location Address
First Line	:	5309 WESTMINSTER CT S
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4825
Country	:	US
Telephone Number	:	817-781-8483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2013
Last Update Date	:	10/17/2013

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