Provider Demographics
NPI:1528496114
Name:BOCKS, JARED (BCABA)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:BOCKS
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 WESTMINSTER CT S
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-4825
Mailing Address - Country:US
Mailing Address - Phone:817-781-8483
Mailing Address - Fax:
Practice Address - Street 1:5309 WESTMINSTER CT S
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-4825
Practice Address - Country:US
Practice Address - Phone:817-781-8483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst