Provider Demographics
NPI:1881033850
Name:ORROCK, JASON SOUTHALL (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SOUTHALL
Last Name:ORROCK
Suffix:
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-1262
Mailing Address - Country:US
Mailing Address - Phone:434-987-3669
Mailing Address - Fax:
Practice Address - Street 1:1030 S BRUNDIDGE ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3121
Practice Address - Country:US
Practice Address - Phone:434-987-3669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-22
Last Update Date:2013-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3143101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional