Individual
STACEY KAY MOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
433 SHELTON LN, RUSSELLVILLE, KY 42276-7600
(270) 901-5000
Mailing address
380 SUWANNEE TRAIL ST, BOWLING GREEN, KY 42103-7956
(270) 901-5000
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
260182
KY
Other
Enumeration date
04/12/2021
Last updated
03/24/2025
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