Individual
BROCK ROADHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
231 S 3RD ST, LAS VEGAS, NV 89101-5914
(702) 468-7218
Mailing address
231 S 3RD ST, LAS VEGAS, NV 89101-5914
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
103TB0200X
NV
Other
Enumeration date
12/30/2013
Last updated
12/30/2013
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