Broderick Webster Sr., LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

793 Tennessee St
Bolivar, TN 38008-2441

Phone

(731) 228-9068

Fax

(901) 425-9773

NPI assigned

Dec 21, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/ACGHDD/Endpoint/ACGHDD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Websters Recovery

  • Mental Health Counselor
  • Memphis, TN
  • NPI 1750125498
  NPD Authorized official
• Brown Behavioral Health Services

  • Rural Health Clinic/Center
  • Bolivar, TN
  • NPI 1699416636
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1703116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1124897996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "844 SHERIDAN ST",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381074611",
            "telephone_number": "901-620-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "793 TENNESSEE ST",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380082441",
            "telephone_number": "731-228-9068",
            "fax_number": "901-425-9773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEBSTER",
        "first_name": "BRODERICK",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-21",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "contact@brownbehavioral.com",
            "affiliation": "Y",
            "endpointDescription": "email",
            "affiliationName": "Brown Behavioral Health Services",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "793 Tennessee St",
            "city": "Bolivar",
            "state": "TN",
            "country_code": "US",
            "postal_code": "380082441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• James William Varner, M.D.
• Wal-Mart Stores East LP
• George W Walters, Jr, O.D.
• Patricia N Warren
• Kelvin Washington
• Lance Austin Wheeler, PT
• Catherine Ann White, LSW
• Danielle Whitehurst, MD
• Darshanula Wilkes
• Bruce Wilks, LADAC

• Mental Health Counselor in Bolivar, TN
• Providers in Bolivar, TN by specialty
• Mental Health Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.