Provider Demographics
NPI:1548082746
Name:ADAM BROCK COUNSELING
Entity type:Organization
Organization Name:ADAM BROCK COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP
Authorized Official - Phone:308-930-9923
Mailing Address - Street 1:4505 CALVIN DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-8715
Mailing Address - Country:US
Mailing Address - Phone:308-930-9923
Mailing Address - Fax:
Practice Address - Street 1:2822 W STOLLEY PARK RD STE 101
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-6806
Practice Address - Country:US
Practice Address - Phone:308-930-9923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty