Individual
MS. CRYSTA JEAN BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1630 N BLACKWELDER AVE # 5, OKLAHOMA CITY, OK 73106-2074
(405) 400-7007
(405) 400-7007
Mailing address
1630 N BLACKWELDER AVE # 5, OKLAHOMA CITY, OK 73106-2074
(405) 400-7007
(405) 400-7007
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5742
OK
101YP2500X
Professional Counselor
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100728800C
—
OK
Enumeration date
05/31/2013
Last updated
05/28/2020
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