Healthcare Provider Details

I. General information

NPI: 1285819532
Provider Name (Legal Business Name): KATRINA A BROCK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E HURON AVE
BAD AXE MI
48413-1312
US

IV. Provider business mailing address

443 N STATE ST
CARO MI
48723-1539
US

V. Phone/Fax

Practice location:
  • Phone: 989-975-6696
  • Fax: 800-878-4243
Mailing address:
  • Phone: 989-672-6160
  • Fax: 800-211-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801082828
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801082828
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-00662
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: