Individual
KAYCE BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
711 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-4717
(918) 207-0078
Mailing address
711 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-4717
(918) 207-0078
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/11/2017
Last updated
10/05/2020
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