Provider Demographics
NPI:1053860585
Name:REBECCA FROCK MA, LPCC
Entity Type:Organization
Organization Name:REBECCA FROCK MA, LPCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:FROCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-507-9087
Mailing Address - Street 1:320 OSUNA RD NE
Mailing Address - Street 2:SUITE 4H
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5952
Mailing Address - Country:US
Mailing Address - Phone:505-507-9087
Mailing Address - Fax:505-345-2878
Practice Address - Street 1:320 OSUNA RD NE
Practice Address - Street 2:SUITE 4H
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5952
Practice Address - Country:US
Practice Address - Phone:505-507-9087
Practice Address - Fax:505-345-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1314305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM82179816Medicaid