NPIMap

Organization Active NPI

Brock Family Therapy Center Inc.

  • Adult Mental Health Clinic/Center
  • Louisville, KY
National Provider Identifier
1609250992
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
0617 Issued in KY
Legal business name
BROCK FAMILY THERAPY CENTER INC.
Practice address
10300 Brookridge Village Blvd
Suite 104
Louisville, KY 40291
Phone
(502) 785-4322
Fax
(502) 785-4433
NPI assigned
Jul 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Authorized official

Name
Mrs. Angela C Brock, LCSW, LMFT, MBANPI 1073734927
Title
Principal Therapist/Owner
Phone
(502) 785-4322

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 3035 KY
Adult Mental Health Clinic/Center 261QM0850X 0617 KY Primary

Addresses

Primary practice location

10300 Brookridge Village Blvd
Suite 104
Louisville, KY 40291

Mailing address

10300 Brookridge Village Blvd
Suite 104
Louisville, KY 40291
Phone (502) 785-4322

Other practice location 1

9700 Park Plaza Ave Unit 210
Louisville, KY 40241-2287
Phone (502) 785-4322

Other identifiers 1

IdentifierTypeStateIssuer
7100068240MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150903002947 KY Part B Supplier - Clinic/Group Practice 7315253416 Receives reassigned benefits from 17 practitioners
Practice locations: Louisville, KY

National Provider Directory

National Provider Directory

Locations

3431 Stony Spring Cir
Louisville, KY 40220
Phone (502) 398-5880

10300 Brookridge Village Blvd
Ste 104
Louisville, KY 40291
Phone (502) 727-8697

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1437004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1609250992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10300 BROOKRIDGE VILLAGE BLVD",
            "address_2": "SUITE 104",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40291",
            "telephone_number": "502-785-4322",
            "fax_number": "502-785-4433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10300 BROOKRIDGE VILLAGE BLVD",
            "address_2": "SUITE 104",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40291",
            "telephone_number": "502-785-4322",
            "fax_number": "502-785-4433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9700 Park Plaza Ave Unit 210",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402412287",
            "country_code": "US",
            "telephone_number": "502-785-4322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BROCK FAMILY THERAPY CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-16",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRINCIPAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "502-785-4322",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW, LMFT, MBA"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "KY",
            "license": "3035",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "KY",
            "license": "0617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100068240",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.