MEDICARE: JODY BOCKORNY LPC-MH

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	LPC-MH20419	SD

General Provider Information

NPI Number	:	1427864065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY BOCKORNY LPC-MH

Provider Business Mailing Address
First Line	:	3701 W 49TH ST STE 204A
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 W 49TH ST STE 204A
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4255
Country	:	US
Telephone Number	:	605-681-3345
Fax Number	:

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

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	12/09/2024

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