MEDICARE: DR. DEBORAH ANN BROCK PSY.D.

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	103TC0700X	Clinical Psychologist	24719	TX

General Provider Information

NPI Number	:	1750381067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH ANN BROCK PSY.D.

Provider Business Mailing Address
First Line	:	900 AUSTIN AVE
Second Line	:	SUITE 500
City	:	WACO
State	:	TX
Zip	:	76701-1902
Country	:	US
Telephone Number	:	254-753-7888
Fax Number	:	254-714-1737

Provider Business Practice Location Address
First Line	:	900 AUSTIN AVE
Second Line	:	SUITE 500
City	:	WACO
State	:	TX
Zip	:	76701-1902
Country	:	US
Telephone Number	:	254-753-7888
Fax Number	:	254-714-1737

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/09/2007

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