Provider Demographics
NPI:1215063664
Name:KLOCK, SCOTT CHRISTIAN II (MED, LPC, LMFT, NCC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:CHRISTIAN
Last Name:KLOCK
Suffix:II
Gender:M
Credentials:MED, LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 TRIBUNE ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5731
Mailing Address - Country:US
Mailing Address - Phone:504-756-2989
Mailing Address - Fax:
Practice Address - Street 1:3001 5TH ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1865
Practice Address - Country:US
Practice Address - Phone:504-756-2989
Practice Address - Fax:504-832-4040
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health