MEDICARE: JULIET BROCK LPC

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	101YP2500X	Professional Counselor	3285	MS

General Provider Information

NPI Number	:	1588496962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIET BROCK LPC

Provider Business Mailing Address
First Line	:	1905 MISSION 66
Second Line	:
City	:	VICKSBURG
State	:	MS
Zip	:	39180-3711
Country	:	US
Telephone Number	:	601-738-5820
Fax Number	:

Provider Business Practice Location Address
First Line	:	341 EDGEWOOD TERRACE DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-6217
Country	:	US
Telephone Number	:	601-738-5820
Fax Number	:

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

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	12/02/2025

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