Basic Information
| Provider Information | |||||||||
| NPI: | 1053402636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORROCK | ||||||||
| FirstName: | TOM | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1713 | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957591713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166855258 | ||||||||
| FaxNumber: | 5306222793 | ||||||||
| Practice Location | |||||||||
| Address1: | 8841 WILLIAMSON DR STE 40 | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956241800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166855258 | ||||||||
| FaxNumber: | 5306222793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC32858 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.