Individual
BROCK FORD TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
991 PARALLEL DR, LAKEPORT, CA 95453-5720
(707) 994-7090
(707) 994-7096
Mailing address
PO BOX 1358, COBB, CA 95426-1358
(707) 928-9600
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
MENTAL HEALTH WAIVER
CA
Other
Enumeration date
12/12/2006
Last updated
07/08/2007
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