| Doctor Name: | MRS. JACQUELINE MARIE BROCK |
| NPI Number: | 1386019123 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 70143 |
| Business Practice Address: | 3106 S W S Young Dr Suite 201-b Killeen, TX - 765422000 |
| Business Phone Number: | 2549394026 |
| Business Fax Number: | 2549392334 |
| Mailing Address: | 3500 S Interstate 35, BELTON |
| State: | TX |
| Postal Code: | 765139426 |
| Phone Number: | 2549394026 |
| Fax Number: | 2549392334 |
| NPI Enumeration Date: | 12/04/2015 |
| NPI Last Update Date: | 03/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 70143 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |