Provider Demographics
NPI:1053141093
Name:BEDROCK MENTAL HEALTH LLC
Entity type:Organization
Organization Name:BEDROCK MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARROUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-214-5553
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-0014
Mailing Address - Country:US
Mailing Address - Phone:864-214-5553
Mailing Address - Fax:
Practice Address - Street 1:322 MEMORIAL DR STE 105
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1521
Practice Address - Country:US
Practice Address - Phone:864-214-5553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty