MEDICARE: TAMMY BROOKLYN BROCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW00001231	KY

General Provider Information

NPI Number	:	1063353639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY BROOKLYN BROCK

Provider Business Mailing Address
First Line	:	720 BRYANT ST APT 1
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-1008
Country	:	US
Telephone Number	:	606-275-9822
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 TRILLIUM WAY
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-8426
Country	:	US
Telephone Number	:	606-528-1212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ TAMMY BROOKLYN BROCK ” Practice Location

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