MR. CARY GLEN BROCK (NPI# 1689937724) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689937724 |
| Entity Type | Individual |
| Full Name | MR. CARY GLEN BROCK |
| Credential | QMHP |
| Practice Address |
155 W Columbia Ln Irrigon OR 97844-6900 |
| Practice Telephone | 5417014863 |
| Mailing Telephone | 5417014863 |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2012-06-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
155 W COLUMBIA LN |
| City | IRRIGON |
| State | OR |
| Zip Code | 97844-6900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093284705 | Jon Watson | Physician Assistant | 220 Ne Main Street, Irrigon, OR 97844 | 2018-11-26 |
| 1952331282 | Morrow County Health District | Clinic/Center | 220 N. Main St., Irrigon, OR 97844 | 2006-07-03 |
| 1427689595 | Jamie Inez Reed | Social Worker | 220 Ne Main Ave, Irrigon, OR 97844 | 2020-01-28 |
| 1578873477 | John Richard Adair | Physician Assistant | 220 Main Street, Irrigon, OR 97844 | 2010-10-14 |
| 1548800097 | Katie Lynn Mencos | Physician Assistant | 220 Ne Main Ave, Irrigon, OR 97844-6999 | 2020-01-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548800097 | Katie Lynn Mencos | Physician Assistant | 220 Ne Main Ave, Irrigon, OR 97844-6999 | 2020-01-13 |
| 1093284705 | Jon Watson | Physician Assistant | 220 Ne Main Street, Irrigon, OR 97844 | 2018-11-26 |
| 1952331282 | Morrow County Health District | Clinic/Center | 220 N. Main St., Irrigon, OR 97844 | 2006-07-03 |
| 1427689595 | Jamie Inez Reed | Social Worker | 220 Ne Main Ave, Irrigon, OR 97844 | 2020-01-28 |
| 1578873477 | John Richard Adair | Physician Assistant | 220 Main Street, Irrigon, OR 97844 | 2010-10-14 |
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508467333 | Paula J. Bloom | Counselor | 66 Club Rd Ste No350, Eugene, OR 97401-2420 | 2020-11-06 |
| 1902406903 | Karen Elizabeth Sanchez Dean | Counselor | 1957 Lemming Ave, Eugene, OR 97401-7231 | 2020-10-28 |
| 1356941629 | Alexandra Suzanne Parker | Counselor | 1600 Valley River Dr Ste 100, Eugene, OR 97401-2141 | 2020-10-27 |
| 1972103497 | Josalyn Lawrence | Counselor | 550 S Main St Ste 105, Lebanon, OR 97355-3335 | 2020-10-26 |
| 1932708559 | Laurie Sue Urbach | Counselor | 501 Sw Western Ave, Grants Pass, OR 97526-5811 | 2020-10-23 |
| 1720687676 | Bree Burch Counseling LLC | Counselor | 19781 Baneberry Ave, Bend, OR 97702-3360 | 2020-10-21 |
| 1336748243 | Jessica M Feinsmith | Counselor | 6530 N Williams Ave, Portland, OR 97217-1924 | 2020-10-21 |
| 1720687809 | Karissa Myriah Gregory | Counselor | 14255 Se Rupert Dr, Portland, OR 97267-1211 | 2020-10-20 |
| 1528667904 | Zuzana Sakova | Counselor | 819 Se Morrison St Ste 225, Portland, OR 97214-6311 | 2020-10-18 |
| 1225637671 | Lisa Sturdivant | Counselor | 17321 Sw Woodhaven Dr, Sherwood, OR 97140-8225 | 2020-10-17 |
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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.