Provider Demographics
NPI:1053402636
Name:ORROCK, TOM (MFT)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:ORROCK
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1713
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95759-1713
Mailing Address - Country:US
Mailing Address - Phone:916-685-5258
Mailing Address - Fax:530-622-2793
Practice Address - Street 1:8841 WILLIAMSON DR STE 40
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1800
Practice Address - Country:US
Practice Address - Phone:916-685-5258
Practice Address - Fax:530-622-2793
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32858106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist