Provider Demographics
NPI:1821787714
Name:BROCK, RICHARD B (LPC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:BROCK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 BUTLER HILL RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-8645
Mailing Address - Country:US
Mailing Address - Phone:318-540-3223
Mailing Address - Fax:
Practice Address - Street 1:8932 JEWELLA AVE STE A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2117
Practice Address - Country:US
Practice Address - Phone:318-540-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional