| Brock Family Therapy Center Inc. | |
|
10300 Brookridge Village Blvd Suite 104 Louisville KY 40291 | |
| (502) 785-4322 | |
| (502) 785-4433 |
| Full Name | Brock Family Therapy Center Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 10300 Brookridge Village Blvd, Louisville, Kentucky |
| Authorized Official Name and Position | Angela C Brock (PRINCIPAL THERAPIST/OWNER) |
| Authorized Official Contact | 5027854322 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brock Family Therapy Center Inc. 10300 Brookridge Village Blvd Suite 104 Louisville KY 40291 Ph: (502) 785-4322 | Brock Family Therapy Center Inc. 10300 Brookridge Village Blvd Suite 104 Louisville KY 40291 Ph: (502) 785-4322 |
| NPI Number | 1609250992 |
|---|---|
| Provider Enumeration Date | 07/16/2015 |
| Last Update Date | 08/21/2023 |
| Certification Date | 08/21/2023 |
| Medicare PECOS PAC ID | 7315253416 |
|---|---|
| Medicare Enrollment ID | O20150903002947 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609250992 | NPI | - | NPPES |
| 7100068240 | Medicaid | KY |
| Provider Name | Cynthia P Corbin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932212388 PECOS PAC ID: 9739093220 Enrollment ID: I20031118000895 |
| Provider Name | Angela C Brock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073734927 PECOS PAC ID: 1557422243 Enrollment ID: I20081213000174 |
| Provider Name | Geoffrey L Elmore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861957979 PECOS PAC ID: 3274959127 Enrollment ID: I20200821002406 |
| Provider Name | Carol A Scott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346287885 PECOS PAC ID: 0840699203 Enrollment ID: I20210604001579 |
| Provider Name | Katie R Gangler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619391638 PECOS PAC ID: 9335525716 Enrollment ID: I20221010000124 |
| Provider Name | Megan Elizabeth Mccarthy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750926168 PECOS PAC ID: 6800245630 Enrollment ID: I20231205003704 |
| Provider Name | Tiffany Dawn Pierson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992395636 PECOS PAC ID: 6204286396 Enrollment ID: I20240102003198 |
| Provider Name | Avani Atul Goodloe |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1891357059 PECOS PAC ID: 0840641627 Enrollment ID: I20240105001080 |
| Provider Name | Heather Lee Mitchell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528799558 PECOS PAC ID: 0941651186 Enrollment ID: I20240111003472 |
| Provider Name | Stephanie Walker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922668367 PECOS PAC ID: 1850737040 Enrollment ID: I20240311001512 |
| Provider Name | Rachel Gilbert |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1477937795 PECOS PAC ID: 8224475447 Enrollment ID: I20240325000354 |
| Provider Name | Jacob Alexander Hass |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1427714005 PECOS PAC ID: 0143661579 Enrollment ID: I20240515003766 |
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