Healthcare Provider Details

I. General information

NPI: 1245024116
Provider Name (Legal Business Name): WENDY S BROCK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY STEPHENS LMSW

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/13/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W JACKSON RD
CARROLLTON TX
75006-1356
US

IV. Provider business mailing address

PO BOX 1081
JUSTIN TX
76247-1081
US

V. Phone/Fax

Practice location:
  • Phone: 972-242-2182
  • Fax:
Mailing address:
  • Phone: 940-236-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111928
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: