1114150307 NPI number — MR. JOSEPH EDWARD BROOME MA, LMHC, CMHS, EMHS

Table of content: MR. JOSEPH EDWARD BROOME MA, LMHC, CMHS, EMHS (NPI 1114150307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114150307 NPI number — MR. JOSEPH EDWARD BROOME MA, LMHC, CMHS, EMHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOME
Provider First Name:
JOSEPH
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMHC, CMHS, EMHS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114150307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 WELLS AVE S UNIT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98057-2786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-295-0624
Provider Business Mailing Address Fax Number:
888-274-5277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 WELLS AVE S UNIT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-295-0624
Provider Business Practice Location Address Fax Number:
888-274-5277
Provider Enumeration Date:
09/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH 60200686 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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