Provider Demographics
NPI:1427068808
Name:BROCK, MARTHA WILEY (LPC, LMFT)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:WILEY
Last Name:BROCK
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-1117
Mailing Address - Country:US
Mailing Address - Phone:972-208-6487
Mailing Address - Fax:972-889-2482
Practice Address - Street 1:100 N CENTRAL EXPY
Practice Address - Street 2:SUITE 614
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5332
Practice Address - Country:US
Practice Address - Phone:972-889-2487
Practice Address - Fax:974-889-2482
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11428101YP2500X
TX0003444106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003849LCOtherBCBS
TX126325OtherVALUE OPTION PROVIDER NUM