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General NPI Number Information
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NPI Number | 1407105661
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Entity Type | Individual
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Provider Name | BROCK S HOWICK LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 791 N 2300 W
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City | TREMONTON
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State | UT
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Zip | 84337-9331
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Country | US
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Telephone | 801-910-9412
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Fax |
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Provider Business Mailing Address
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Address Line | 134 W 1180 N
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City | TOOELE
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State | UT
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Zip | 84074-1483
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 85915933501
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License Number State | UT
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