Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LH 00009706 | WA |
NPI | 1003024738 |
---|---|
Provider Name | Catherine M. Brock |
First Address | Newport Beach, CA 92658-1223 |
Second Address | Long Beach, CA 90803-5079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 04/11/2021 |