Individual
TIFFANY D BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
65 OLD SPRINGFIELD RD, LEBANON, KY 40033-9185
(270) 692-2509
(270) 692-2592
Mailing address
65 OLD SPRINGFIELD RD, LEBANON, KY 40033-9185
(270) 692-2509
(270) 692-2592
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1052
KY
Other
Enumeration date
10/05/2007
Last updated
07/22/2014
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