Provider Demographics
NPI:1629289376
Name:ROCK, KRISTIN TERESA (LPC-MH, QMHP)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:TERESA
Last Name:ROCK
Suffix:
Gender:F
Credentials:LPC-MH, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 MOUNT RUSHMORE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8200
Mailing Address - Country:US
Mailing Address - Phone:605-737-1308
Mailing Address - Fax:605-388-8003
Practice Address - Street 1:1107 MOUNT RUSHMORE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8200
Practice Address - Country:US
Practice Address - Phone:605-737-1308
Practice Address - Fax:605-388-8003
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD04111202101YA0400X
SDLPC-MH2134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health