Provider Demographics
NPI:1194022095
Name:BROCK, CINDY LYNN (MA, PCCI)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:LYNN
Last Name:BROCK
Suffix:
Gender:F
Credentials:MA, PCCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27403 YNEZ RD STE 202
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4616
Mailing Address - Country:US
Mailing Address - Phone:951-231-1667
Mailing Address - Fax:
Practice Address - Street 1:27403 YNEZ RD STE 202
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4616
Practice Address - Country:US
Practice Address - Phone:951-231-1667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-12
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YM0800X, 101Y00000X
CAPCCI1316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health