Healthcare Provider Details

I. General information

NPI: 1225750078
Provider Name (Legal Business Name): JAMESON BOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W CENTER RD # NE68106
OMAHA NE
68106-2714
US

IV. Provider business mailing address

PO BOX 6476
OMAHA NE
68106-0476
US

V. Phone/Fax

Practice location:
  • Phone: 402-506-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3457
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2872
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number136012
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: