MEDICARE: ADAM BOCKHORST PCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	E.0900448	OH

General Provider Information

NPI Number	:	1114367141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM BOCKHORST PCC

Provider Business Mailing Address
First Line	:	2300 MONTANA AVE
Second Line	:	SUITE 207
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3829
Country	:	US
Telephone Number	:	513-202-3610
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 MONTANA AVE
Second Line	:	SUITE 207
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3829
Country	:	US
Telephone Number	:	513-202-3610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2013
Last Update Date	:	07/05/2013

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