Provider Demographics
NPI:1609461573
Name:TURNBAUGH, BROCK (LGPC)
Entity Type:Individual
Prefix:
First Name:BROCK
Middle Name:
Last Name:TURNBAUGH
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 SHALLOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-2101
Mailing Address - Country:US
Mailing Address - Phone:443-536-1848
Mailing Address - Fax:
Practice Address - Street 1:7524 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7594
Practice Address - Country:US
Practice Address - Phone:443-328-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11252101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional