Doctor Name: | MR. CLAUD RANDALL SCHROCK |
NPI Number: | 1609931062 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.M.H.C. |
License Number: | 39000671A |
Business Practice Address: | 12501 N State Road 49 Wheatfield, IN - 463928986 |
Business Phone Number: | 2198719388 |
Business Fax Number: | |
Mailing Address: | Po Box 119, LA CROSSE |
State: | IN |
Postal Code: | 463480119 |
Phone Number: | 2197542564 |
Fax Number: | |
NPI Enumeration Date: | 12/26/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 39000671A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |