MEDICARE: EMILY ELIZABETH ROCK MS

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	101YM0800X	Mental Health Counselor	LH60771528	WA

General Provider Information

NPI Number	:	1508402645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ELIZABETH ROCK MS

Provider Business Mailing Address
First Line	:	PO BOX 21019
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4107
Country	:	US
Telephone Number	:	206-352-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	RAIN CITY INTEGRATIVE CLINIC
Second Line	:	2730 WESTLAKE AVE N
City	:	SEATTLE
State	:	WA
Zip	:	98109
Country	:	US
Telephone Number	:	206-352-9000
Fax Number	:

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

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	11/25/2019

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