Provider Demographics
NPI:1710760418
Name:BROCK, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BROCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W OTIS AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-8713
Mailing Address - Country:US
Mailing Address - Phone:785-825-0541
Mailing Address - Fax:
Practice Address - Street 1:1811 W 2ND ST STE 105
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5400
Practice Address - Country:US
Practice Address - Phone:785-825-0541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health