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General NPI Number Information
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NPI Number | 1043125099
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Entity Type | Individual
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Provider Name | MYRANDA BROCK LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2026
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Last Update Date | 08/15/2026
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Provider Practice Location Address
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Address Line | 6971 N FEDERAL HWY STE 206
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City | BOCA RATON
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State | FL
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Zip | 33487-1648
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Country | US
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Telephone | 561-408-1098
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Fax |
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Provider Business Mailing Address
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Address Line | 8089 TUMBLESTONE CT APT 633
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City | DELRAY BEACH
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State | FL
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Zip | 33446-4429
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Country | US
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Telephone | 954-663-8478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH25315
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License Number State | FL
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