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General NPI Number Information
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NPI Number | 1053876227
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Entity Type | Organization
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Legal Business Name | LISA BROCK COUNSELING
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 4943 OLD GREENWOOD RD STE 9
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City | FORT SMITH
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State | AR
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Zip | 72903-6923
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Country | US
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Telephone | 479-461-7789
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Fax |
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Provider Business Mailing Address
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Address Line | 8600 GATEHOUSE WAY
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City | FORT SMITH
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State | AR
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Zip | 72916-6022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. LISA BROCK
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Credential | LPC LMFT
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Telephone | 479-461-7789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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