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NPI Code Detail

MEDICARE: MR. JOHN H. PROCK MFT

MEDICARE: MR. JOHN H. PROCK MFT
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
1106H00000XMarriage & Family TherapistMFC 19707CA

General Provider Information

NPI Number : 1730245762
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN H. PROCK MFT
Provider Business Mailing Address
First Line : 6980 CRYSTAL BLVD
Second Line :
City : EL DORADO
State : CA
Zip : 95623-4866
Country : US
Telephone Number : 530-620-5577
Fax Number :
Provider Business Practice Location Address
First Line : 6980 CRYSTAL BLVD
Second Line :
City : EL DORADO
State : CA
Zip : 95623-4866
Country : US
Telephone Number : 530-620-5577
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2006
Last Update Date : 07/08/2007

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Directions to “ MR. JOHN H. PROCK MFT” Practice Location

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