MEDICARE: LOU ANN TODD MOCK PHD

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	103T00000X	Psychologist	2-1432	TX

General Provider Information

NPI Number	:	1871673285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOU ANN TODD MOCK PHD

Provider Business Mailing Address
First Line	:	1807 LEXINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4303
Country	:	US
Telephone Number	:	713-802-3839
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 LEXINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4303
Country	:	US
Telephone Number	:	713-802-3839
Fax Number	:

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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