Healthcare Provider Details

I. General information

NPI: 1558817619
Provider Name (Legal Business Name): JOHN W SCHOCK LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

IV. Provider business mailing address

240 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-1928
  • Fax: 765-741-0362
Mailing address:
  • Phone: 765-288-1928
  • Fax: 765-741-0362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number39003406A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003406A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: