Individual
BENNETT ALEXANDER BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
440 MAXWELL RD, EUGENE, OR 97404-2355
(541) 321-0872
Mailing address
PO BOX 827, EUGENE, OR 97440-0827
(541) 321-0872
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
QMHP-R-3693
OR
Other
Enumeration date
10/02/2024
Last updated
06/26/2025
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