Provider Demographics
NPI:1568560886
Name:SPROCK, JUNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:
Last Name:SPROCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 NOTTINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2078
Mailing Address - Country:US
Mailing Address - Phone:812-877-3201
Mailing Address - Fax:
Practice Address - Street 1:INDIANA STATE UNIVERSITY PSYCHOLOGY CLINIC
Practice Address - Street 2:450 NORTH 7TH STREET
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47809-0001
Practice Address - Country:US
Practice Address - Phone:812-237-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040268103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist