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General NPI Number Information
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NPI Number | 1609931062
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Entity Type | Individual
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Provider Name | CLAUD RANDALL SCHROCK LMHC
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 1317 15TH ST SE
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City | DEMOTTE
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State | IN
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Zip | 46310-9393
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Country | US
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Telephone | 219-477-5646
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Fax | 219-728-4765
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Provider Business Mailing Address
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Address Line | 2004 VALPARAISO ST
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City | VALPARAISO
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State | IN
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Zip | 46383-3138
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Country | US
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Telephone | 219-477-5646
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Fax | 219-728-4765
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39000671A
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License Number State | IN
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