Individual
CARLY BROADHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, NCC, LPC
Contact information
Practice address
3071 E FRANKLIN RD STE 201, MERIDIAN, ID 83642
(208) 807-2877
Mailing address
11828 W FAIRVIEW AVE APT 202, BOISE, ID 83713-7802
(986) 200-9268
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MH3237
—
AK
Enumeration date
07/23/2013
Last updated
03/07/2019
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