Individual
JENNIFER ROSE BROYLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-S, CM2, PTA
Contact information
Practice address
900 BROADWAY, SUITE 1, POTEAU, OK 74953
(918) 649-0772
Mailing address
900 BROADWAY, SUITE 1, POTEAU, OK 74953
(918) 649-0772
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
SUPERVISION
OK
225200000X
Physical Therapy Assistant
1896
AR
Other
Enumeration date
02/14/2012
Last updated
07/11/2016
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