Healthcare Provider Details

I. General information

NPI: 1922393248
Provider Name (Legal Business Name): JOYCE KLOCK URBAN M.A., L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 SE 18TH PLACE SUITE 400
OCALA FL
34471-5422
US

IV. Provider business mailing address

1130 SE 18TH PLACE SUITE 400
OCALA FL
34471-5422
US

V. Phone/Fax

Practice location:
  • Phone: 352-390-6656
  • Fax: 352-390-8756
Mailing address:
  • Phone: 352-390-6656
  • Fax: 352-390-8756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: