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General NPI Number Information
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NPI Number | 1609461573
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Entity Type | Individual
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Provider Name | BROCK TURNBAUGH LGPC
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Gender | Male
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 7524 MAIN ST STE 101
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City | SYKESVILLE
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State | MD
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Zip | 21784-7594
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Country | US
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Telephone | 443-328-4946
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Fax |
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Provider Business Mailing Address
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Address Line | 4590 SHALLOW SPRINGS DR
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City | MANCHESTER
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State | MD
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Zip | 21102-2101
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Country | US
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Telephone | 443-536-1848
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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 | LGP11252
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License Number State | MD
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