| Doctor Name: | CHARLOTTE SHROCK |
| NPI Number: | 1003080250 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 5120 Hwy 54 Ne Northwest Center For Behavioral Health Guymon, OK - 73942 |
| Business Phone Number: | 5803385851 |
| Business Fax Number: | 5803386022 |
| Mailing Address: | 1222 10th Street, Suite 211northwest Center For Behavioral Health WOODWARD |
| State: | OK |
| Postal Code: | 738013156 |
| Phone Number: | 5803385851 |
| Fax Number: | 5803386022 |
| NPI Enumeration Date: | 04/18/2008 |
| NPI Last Update Date: | 04/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |