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General NPI Number Information
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NPI Number | 1205428653
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Entity Type | Individual
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Provider Name | BROCK RAMIREZ
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Gender | Male
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 109 S WOODROW LN STE 300
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City | DENTON
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State | TX
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Zip | 76205-6324
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Country | US
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Telephone | 940-765-6487
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Fax |
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Provider Business Mailing Address
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Address Line | 223 LILAC LN
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7411
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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 |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 84621
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License Number State | TX
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