MEDICARE: MS. MARTHA WILEY BROCK LPC, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	11428	TX
2	106H00000X	Marriage & Family Therapist	0003444	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0003849LC	OTHER	TX	BCBS
2	126325	OTHER	TX	VALUE OPTION PROVIDER NUM

General Provider Information

NPI Number	:	1427068808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA WILEY BROCK LPC, LMFT

Provider Business Mailing Address
First Line	:	3533 LOUIS DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-1117
Country	:	US
Telephone Number	:	972-208-6487
Fax Number	:	972-889-2482

Provider Business Practice Location Address
First Line	:	100 N CENTRAL EXPY
Second Line	:	SUITE 614
City	:	RICHARDSON
State	:	TX
Zip	:	75080-5332
Country	:	US
Telephone Number	:	972-889-2487
Fax Number	:	974-889-2482

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	09/11/2025

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