Active NPI
Deborah Lynn Brock, PHD
- Professional Counselor
- Lodi, WI
National Provider Identifier
1679519953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2855-125
- Practice address
- 336 Lodi St
Lodi, WI 53555-1418 - Phone
- (608) 592-2080
- Fax
- (608) 592-7120
- NPI assigned
- Jun 22, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2855-125 | WI | Primary |
Addresses
Primary practice location
336 Lodi St
Lodi, WI 53555-1418
Mailing address
336 Lodi St
Lodi, WI 53555-1418
Phone (608) 592-2080
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2855-125 | WI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midlands Psychological Associates, LLC | Past | Accepting new patients |
Organizations & group practices 1
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 Psychologist
- Lodi, WI
- NPI 1285676593
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363564800000",
"number": "1679519953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "336 LODI ST",
"city": "LODI",
"state": "WI",
"postal_code": "535551418",
"telephone_number": "608-592-2080",
"fax_number": "608-592-7120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "336 LODI ST",
"city": "LODI",
"state": "WI",
"postal_code": "535551418",
"telephone_number": "608-592-2080",
"fax_number": "608-592-7120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCK",
"first_name": "DEBORAH",
"middle_name": "LYNN",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-22",
"last_updated": "2013-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "2855-125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lodi, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.