Individual
MR. CARY GLEN BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QMHP
Contact information
Practice address
155 W COLUMBIA LN, IRRIGON, OR 97844-6900
(541) 701-4863
Mailing address
155 W COLUMBIA LN, IRRIGON, OR 97844-6900
(541) 701-4863
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/22/2012
Last updated
06/22/2012
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