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General NPI Number Information
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NPI Number | 1760073704
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Entity Type | Individual
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Provider Name | THERESA STOCK MHP
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Gender | Female
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 4600 3RD ST
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City | MOLINE
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State | IL
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Zip | 61265-6106
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Country | US
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Telephone | 309-779-2018
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Fax |
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Provider Business Mailing Address
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Address Line | 3446 PLEASANT DR
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City | BETTENDORF
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State | IA
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Zip | 52722-3947
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Country | US
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Telephone | 309-737-1903
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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