Individual
EMILY BROADHURST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
509 W 10TH ST, ANTIOCH, CA 94509-1653
(925) 777-9540
Mailing address
427 E CENTURY BLVD, LODI, CA 95240-8810
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
PSY34627
CA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY34627
CA
Other
Enumeration date
01/23/2017
Last updated
11/22/2023
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