Provider Demographics
NPI:1427828953
Name:BROCK, CARRIE (LSCSW)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BROCK
Suffix:
Gender:
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W MARLIN ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460
Mailing Address - Country:US
Mailing Address - Phone:620-309-3607
Mailing Address - Fax:620-203-6173
Practice Address - Street 1:103 W MARLIN ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-4229
Practice Address - Country:US
Practice Address - Phone:620-309-3607
Practice Address - Fax:620-203-6173
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7080104100000X
KS066581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker