Provider Demographics
NPI:1689854259
Name:BROCK, MERLE GENE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MERLE
Middle Name:GENE
Last Name:BROCK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 N HEMLOCK CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1298
Mailing Address - Country:US
Mailing Address - Phone:918-615-3435
Mailing Address - Fax:918-615-3436
Practice Address - Street 1:3101 N HEMLOCK CIR STE 100
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1298
Practice Address - Country:US
Practice Address - Phone:918-615-3435
Practice Address - Fax:918-615-3436
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist