Healthcare Provider Details

I. General information

NPI: 1962338657
Provider Name (Legal Business Name): DAVID BROCK
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 OLD RANCH RD
COLORADO SPRINGS CO
80908-4528
US

IV. Provider business mailing address

1123 FLORENCE AVE
COLORADO SPRINGS CO
80905-3547
US

V. Phone/Fax

Practice location:
  • Phone: 719-528-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPCC.0024444
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: