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General NPI Number Information
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NPI Number | 1710215876
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Entity Type | Organization
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Legal Business Name | DENISE A MOCK, PHD, INC
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Dates
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Enumeration Date | 12/01/2009
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Last Update Date | 12/01/2009
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Provider Practice Location Address
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Address Line | 1244 PINE ST STE 208
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City | PASO ROBLES
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State | CA
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Zip | 93446-7240
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Country | US
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Telephone | 805-237-0058
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Fax |
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Provider Business Mailing Address
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Address Line | 1244 PINE ST STE 208
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City | PASO ROBLES
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State | CA
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Zip | 93446-7240
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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 | OWNER
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Name | DR. DENISE A MOCK
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Credential |
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Telephone | 805-237-0058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY17921
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License Number State | CA
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