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Individual
JACQUELYN JOY BROADUS
Active
Individual
JACQUELYN JOY BROADUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH11967
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MH11967
STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISON OF MEDICAL QUALITY ASSURANCE
FL
Enumeration date
08/12/2013
Last updated
08/12/2013
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