Provider Demographics
NPI:1922408665
Name:BROCK, SHALENA CHANTEL (LMSW)
Entity type:Individual
Prefix:
First Name:SHALENA
Middle Name:CHANTEL
Last Name:BROCK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 ABRAHAM CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-6961
Mailing Address - Country:US
Mailing Address - Phone:469-412-5140
Mailing Address - Fax:214-614-4153
Practice Address - Street 1:509 ABRAHAM CT
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-6961
Practice Address - Country:US
Practice Address - Phone:469-412-5140
Practice Address - Fax:214-614-4153
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-31
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54859104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22004798OtherTEXAS HEALTH STEPS