Healthcare Provider Details

I. General information

NPI: 1144907239
Provider Name (Legal Business Name): DAVID ANDREW BLOCK LPC, SAC-IT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 W GRAND AVE STE 250
BELOIT WI
53511-6273
US

IV. Provider business mailing address

136 W GRAND AVE STE 240
BELOIT WI
53511-6259
US

V. Phone/Fax

Practice location:
  • Phone: 608-207-9999
  • Fax:
Mailing address:
  • Phone: 608-207-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05677
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC10698
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20096-130
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11397-125
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberTPMC5894
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3114
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number98418
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.021877
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: