Provider Demographics
NPI:1891192498
Name:BROCK, JOHNNY BRIAN (MS)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:BRIAN
Last Name:BROCK
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6417 US ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-8661
Mailing Address - Country:US
Mailing Address - Phone:606-585-8070
Mailing Address - Fax:
Practice Address - Street 1:6417 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-8661
Practice Address - Country:US
Practice Address - Phone:606-585-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker