BROCK FORD TRAVIS (NPI# 1417018987) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417018987 |
| Entity Type | Individual |
| Full Name | BROCK FORD TRAVIS |
| Credential | PH.D. |
| Practice Address |
991 Parallel Dr Lakeport CA 95453-5720 |
| Mailing Address |
Po Box 1358 Cobb CA 95426-1358 |
| Practice Telephone | 7079947090 |
| Practice Fax Number | 7079947096 |
| Mailing Telephone | 7079289600 |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | MENTAL HEALTH WA | CA | Behavioral Health & Social Service Providers |
| Street Address |
991 PARALLEL DR |
| City | LAKEPORT |
| State | CA |
| Zip Code | 95453-5720 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588029466 | Randall Cole | Counselor | 991 Parallel Dr, Lakeport, CA 95453-5720 | 2015-12-21 |
| 1932477346 | Robert A Montgomery | Counselor | 991 Parallel Dr, Lakeport, CA 95453-5720 | 2011-12-13 |
| 1427356443 | Thomas Leon Brown | Counselor | 991 Parallel Dr, Lakeport, CA 95453-5720 | 2011-03-01 |
| 1922304526 | Mary Lou Floyd | Counselor | 991 Parallel Dr, Lakeport, CA 95453-5720 | 2011-01-31 |
| 1740585819 | Jason Krishna Pofi | Licensed Vocational Nurse | 991 Parallel Dr, Lakeport, CA 95453-5720 | 2011-01-20 |
| 1275838831 | Franklin Dewayne Tuttle Jr. | Counselor | 991 Parallel Dr, Lakeport, CA 95453-5720 | 2011-01-12 |
| 1336380955 | Carolina Rondas Pimenta | Counselor | 991 Parallel Dr, Lakeport, CA 95453-5720 | 2009-03-11 |
| 1689822991 | Mari Ellen Scholvinck | Counselor | 991 Parallel Dr, Lakeport, CA 95453-5720 | 2008-08-29 |
| 1427225119 | Lisa M Bermudez | Counselor | 991 Parallel Dr, Lakeport, CA 95453-5720 | 2008-05-12 |
| 1134399868 | Monnie Marie Smevold | Counselor | 991 Parallel Dr, Lakeport, CA 95453-5720 | 2008-03-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427526847 | Easter Seals Bay Area | Early Intervention Provider Agency | 1950 Parallel Drive, Lakeport, CA 95453 | 2018-11-03 |
| 1285000810 | Lake County Tribal Health Consortium, Inc. | Clinic/Center | 14678 Lakeshore Boulevard, Clearlake, CA 95453 | 2015-08-18 |
| 1942558721 | Lorena A Watson | Nurse Practitioner | 5108 Hill Road East, Lakeport, CA 95453 | 2012-08-27 |
| 1992024657 | Jennifer Stolworthy Smith | Case Manager/Care Coordinator | 991 Parallel Dr. Ste. B, County of Lake, Mental Health, Lakeport, CA 95453 | 2010-05-20 |
| 1376720664 | June Arisa Masato | Marriage & Family Therapist | 1152 S. Main St, Lakeport, CA 95453 | 2008-01-29 |
| 1245417021 | Robert Ryan Taylor Sr. | Physical Therapist | 1285 S Main Street, Lakeport, CA 95453 | 2008-01-24 |
| 1760669618 | Joan Kammerer | Registered Nurse | 922 Bevins Court, Lakeport, CA 95453 | 2008-01-23 |
| 1881878353 | Mary Theresa Mcmillan | Marriage & Family Therapist | 75 Fourth Street, Lakeport, CA 95453 | 2007-12-19 |
| 1922288984 | Robert William Krause | Family Medicine | 755 Eleventh St, Lakeport, CA 95453 | 2007-11-07 |
| 1568683092 | Dan Sleeth | Marriage & Family Therapist | 991 Parallel Dr., Lakeport, CA 95453 | 2007-05-01 |
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| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134147416 | John R Winslow II | Psychologist | 302 Armstrong St, Lakeport, CA 95453-5202 | 2006-07-17 |
| 1972900124 | Allison J. Aclufi | Psychologist | 380 N Main St, Suite J, Lakeport, CA 95453-4843 | 2014-12-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992306690 | Eileen Kay Laughman | Psychologist | 24545 Town Center Dr Apt 5406, Valencia, CA 91355-1397 | 2020-11-08 |
| 1194324954 | Rachel Charman | Psychologist | 1001 Dove St Ste 110, Newport Beach, CA 92660-2845 | 2020-10-22 |
| 1700485760 | Melissa Ernestine Munoz | Psychologist | 353 H St # 1517, Chula Vista, CA 91910-5501 | 2020-10-21 |
| 1235737669 | Maha Nasrallah-babenko | Psychologist | 33442 Valley View Ct, Dana Point, CA 92629-1515 | 2020-10-16 |
| 1689272544 | Kaleidoscope Solutions Family Therapy | Psychologist | 25876 The Old Road, #85, Stevenson Ranch, CA 91381 | 2020-10-13 |
| 1992302814 | Sheena Gill | Psychologist | 2501 E Chapman Ave Ste 265, Fullerton, CA 92831-3108 | 2020-10-04 |
| 1255948600 | Kesha Patrice | Psychologist | 939 Ellis St, San Francisco, CA 94109-7714 | 2020-09-29 |
| 1841807401 | Midori K Dirig | Psychologist | 405 W. 3rd Street, Santa Ana, CA 92701 | 2020-09-28 |
| 1376159541 | Jill Caryn Campbell | Psychologist | 342 Ocho Rios Way, Oak Park, CA 91377-5541 | 2020-09-22 |
| 1225644487 | Brock Louis Pistel | Psychologist | 939 Ellis St Fl 67, San Francisco, CA 94109-7714 | 2020-09-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.