Provider Demographics
NPI:1699716795
Name:BROCK, DAVID H (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:BROCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4218
Mailing Address - Country:US
Mailing Address - Phone:907-727-8555
Mailing Address - Fax:907-562-0780
Practice Address - Street 1:4325 LAUREL ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5338
Practice Address - Country:US
Practice Address - Phone:907-727-8555
Practice Address - Fax:907-562-0780
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK62101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor