Provider Demographics
NPI:1245024116
Name:BROCK, WENDY S (LMSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:BROCK
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-1081
Mailing Address - Country:US
Mailing Address - Phone:940-236-3217
Mailing Address - Fax:
Practice Address - Street 1:1100 W JACKSON RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1356
Practice Address - Country:US
Practice Address - Phone:972-242-2182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111928104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker