MEDICARE: MR. BRANDON JAMES MOCK ATR-BC, LPC, LMFT

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	101YP2500X	Professional Counselor	2002008097	MO
2	106H00000X	Marriage & Family Therapist	684	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	684	OTHER	KS	LMFT

General Provider Information

NPI Number	:	1730248626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRANDON JAMES MOCK ATR-BC, LPC, LMFT

Provider Business Mailing Address
First Line	:	480 S ROGERS RD
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-1706
Country	:	US
Telephone Number	:	913-324-3683
Fax Number	:	913-780-3387

Provider Business Practice Location Address
First Line	:	480 S ROGERS RD
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-1706
Country	:	US
Telephone Number	:	913-324-3683
Fax Number	:	913-780-3387

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	09/07/2011

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