Active NPI
Alicia Brock, MA, LPC
- Professional Counselor
- Laramie, WY
National Provider Identifier
1104175686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-1840
- Practice address
- 1263 N 15TH St
Laramie, WY 82072-2343 - Phone
- (307) 745-8915
- NPI assigned
- Aug 30, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0012319 | CO | |
| Professional Counselor | 101YP2500X | LPC-1840 | WY | Primary |
Addresses
Primary practice location
1263 N 15TH St
Laramie, WY 82072-2343
Mailing address
510 W 29TH St
Cheyenne, WY 82001-2760
Phone (307) 426-4728
Other practice location 1
14221 E 4th Ave
Ste 225
Aurora, CO 80011-8735
Phone (720) 446-6549
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-1840 | WY | MD | Professional Counselor |
| 0012319 | CO | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Other Road Counseling PLLC | Past | Accepting new patients | |
| The Other Road Counseling PLLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Boulder, CO
- NPI 1336873066
-
- Clinical Social Worker
- Boulder, CO
- NPI 1639941271
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583193600000",
"number": "1104175686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 W 29TH ST",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820012760",
"telephone_number": "307-426-4728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1263 N 15TH ST",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820722343",
"telephone_number": "307-745-8915"
}
],
"practiceLocations": [
{
"address_1": "14221 E 4th Ave",
"address_2": "Ste 225",
"address_purpose": "LOCATION",
"city": "Aurora",
"state": "CO",
"postal_code": "800118735",
"country_code": "US",
"telephone_number": "720-446-6549",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BROCK",
"first_name": "ALICIA",
"credential": "MA, LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-30",
"last_updated": "2020-03-03",
"certification_date": "2020-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CO",
"license": "0012319",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WY",
"license": "LPC-1840",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laramie, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.