BROCK FORD TRAVIS

LAKEPORT, CA
NPI1417018987
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy103T00000X Psychologist
(Licence: CA  Mental Health Waiver)
Enumeration Date2006-12-12
Last Update Date2007-07-08
Business Address
-- BROCK FORD TRAVIS Ph.D.
991 PARALLEL DR
LAKEPORT, CA 95453-5720
Phone number: 707-994-7090
Mailing Address
-- BROCK FORD TRAVIS Ph.D.
PO BOX 1358
COBB, CA 95426-1358
Phone number: 707-928-9600
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