Individual
ALICIA BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
1263 N 15TH ST, LARAMIE, WY 82072-2343
(307) 745-8915
Mailing address
510 W 29TH ST, CHEYENNE, WY 82001-2760
(307) 426-4728
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0012319
CO
101YP2500X
Professional Counselor
Primary
LPC-1840
WY
Other
Enumeration date
08/30/2012
Last updated
03/03/2020
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