Provider Demographics
NPI:1124684493
Name:BOCOOK, ARIEL (LCDCII)
Entity type:Individual
Prefix:MS
First Name:ARIEL
Middle Name:
Last Name:BOCOOK
Suffix:
Gender:F
Credentials:LCDCII
Other - Prefix:MS
Other - First Name:ARIEL
Other - Middle Name:
Other - Last Name:BOCOOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDCII
Mailing Address - Street 1:889 INGLESIDE AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3051
Mailing Address - Country:US
Mailing Address - Phone:614-868-2669
Mailing Address - Fax:
Practice Address - Street 1:6434 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7300
Practice Address - Country:US
Practice Address - Phone:614-868-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
161716101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0353459Medicaid