Healthcare Provider Details

I. General information

NPI: 1164216776
Provider Name (Legal Business Name): ALAN F BROCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N OREM BLVD
OREM UT
84057-6601
US

IV. Provider business mailing address

822 S 1040 W
PAYSON UT
84651-4614
US

V. Phone/Fax

Practice location:
  • Phone: 801-609-2448
  • Fax:
Mailing address:
  • Phone: 801-609-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14209911-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: