Provider Demographics
NPI:1730245762
Name:PROCK, JOHN H (MFT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:H
Last Name:PROCK
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6980 CRYSTAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:CA
Mailing Address - Zip Code:95623-4866
Mailing Address - Country:US
Mailing Address - Phone:530-620-5577
Mailing Address - Fax:
Practice Address - Street 1:6980 CRYSTAL BLVD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:CA
Practice Address - Zip Code:95623-4866
Practice Address - Country:US
Practice Address - Phone:530-620-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 19707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist