Crysta Jean Brock, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

5742 Issued in OK

Practice address

1630 N Blackwelder Ave # 5
Oklahoma City, OK 73106-2074

Phone

(405) 400-7007

Fax

(405) 400-7007

NPI assigned

May 31, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Sunbeam Family Services

  • Case Management Agency
  • Oklahoma City, OK
  • NPI 1295179505
  NPD (past)
• Sunbeam Family Services, Inc.

  • Community/Behavioral Health Agency
  • Oklahoma City, OK
  • NPI 1619015005
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590624000000",
    "number": "1447697313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 N BLACKWELDER AVE # 5",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731062074",
            "telephone_number": "405-400-7007",
            "fax_number": "405-400-7007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 N BLACKWELDER AVE # 5",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731062074",
            "telephone_number": "405-400-7007",
            "fax_number": "405-400-7007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "616 NW 21st St",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731031810",
            "country_code": "US",
            "telephone_number": "405-528-7721 x168",
            "fax_number": "405-528-7731",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCK",
        "first_name": "CRYSTA",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-31",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "5742",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100728800C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• BRK, PLLC
• Colby Troy Broadbent, DDS
• Ray W Broadfoot Jr., D.D.S.
• Belinda G Broady-Symes, M.D.
• Bradley Brobst, DO
• Jennifer Brock
• Stephen Brockbank, DDS
• Shella Dawn Brockett
• Jessica McKennon Brody, PH.D.
• Megan Broeker

• Mental Health Counselor in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 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.

Verify at the official NPI Registry.