Individual
KRISTIN M. BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
716 S HIGHWAY 77, NEWKIRK, OK 74647-7009
(580) 362-2555
(580) 362-2948
Mailing address
212 N MAIN ST, FAIRFAX, OK 74637-3023
(918) 642-3100
(918) 642-5639
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3832
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200446140A
—
OK
01
—
287620YRHZ
MEDICARE PTAN
OK
Enumeration date
07/05/2012
Last updated
07/21/2022
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