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General NPI Number Information
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NPI Number | 1881568715
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Entity Type | Individual
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Provider Name | DAVID CORBLY BROCKMAN III LPC, ATR
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Gender | Male
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 10421 S CHURCH ST
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City | CHICAGO
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State | IL
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Zip | 60643-2940
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Country | US
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Telephone | 708-568-1909
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Fax |
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Provider Business Mailing Address
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Address Line | 1334 W BRYN MAWR AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60660-0049
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Country | US
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Telephone | 513-417-5035
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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 | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 24-718
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 178.021187
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License Number State | IL
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