Provider Demographics
NPI:1750406153
Name:GREEK, BROCK RICHARD (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:BROCK
Middle Name:RICHARD
Last Name:GREEK
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 GRACE AVE.
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401
Mailing Address - Country:US
Mailing Address - Phone:307-431-2712
Mailing Address - Fax:307-347-4340
Practice Address - Street 1:718 BIG HORN AVE
Practice Address - Street 2:SUITE D.
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401
Practice Address - Country:US
Practice Address - Phone:307-431-2712
Practice Address - Fax:307-347-4340
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-5921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106352900Medicaid
WY106352903Medicaid