Provider Demographics
NPI:1083309041
Name:SHOCK, BARBARA JEAN (MA, LMFT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:SHOCK
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 HERSCHEL ST N APT 322
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-0033
Mailing Address - Country:US
Mailing Address - Phone:651-983-7948
Mailing Address - Fax:
Practice Address - Street 1:2730 HERSCHEL ST N APT 322
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-0033
Practice Address - Country:US
Practice Address - Phone:651-983-7948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4346106H00000X
MN4346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist