Provider Demographics
NPI:1508231812
Name:BROCK, PHILLIP JR (BA)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:BROCK
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 ELYSIAN FIELDS AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4245
Mailing Address - Country:US
Mailing Address - Phone:504-324-7332
Mailing Address - Fax:504-324-7339
Practice Address - Street 1:6305 ELYSIAN FIELDS AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-4245
Practice Address - Country:US
Practice Address - Phone:504-324-7332
Practice Address - Fax:504-324-7339
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker