Doctor Name: | KRISTIN M. BROCK |
NPI Number: | 1780949883 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 3832 |
Business Practice Address: | 716 S Highway 77 Newkirk, OK - 746477009 |
Business Phone Number: | 5803622555 |
Business Fax Number: | 5803622948 |
Mailing Address: | 212 N Main St, FAIRFAX |
State: | OK |
Postal Code: | 746373023 |
Phone Number: | 9186423100 |
Fax Number: | 9186425639 |
NPI Enumeration Date: | 07/05/2012 |
NPI Last Update Date: | 03/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 3832 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |