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General NPI Number Information
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NPI Number | 1558896506
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Entity Type | Individual
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Provider Name | NICHOLAS TOCK LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1075 E PARK BLVD
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City | BOISE
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State | ID
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Zip | 83712-7722
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Country | US
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Telephone | 208-381-5970
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Fax | 208-381-5971
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.09928268
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801117495
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-40831
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License Number State | ID
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