Active NPI
Robert Broadwell, MA, LPC
- Professional Counselor
- Corunna, MI
National Provider Identifier
1154501229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401003658
- Practice address
- 301 N Shiawassee St
Box 129
Corunna, MI 48817-1439 - Phone
- (989) 743-1007
- NPI assigned
- Nov 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401003658 | MI | Primary |
Addresses
Primary practice location
301 N Shiawassee St
Box 129
Corunna, MI 48817-1439
Mailing address
301 N Shiawassee St
Box 129
Corunna, MI 48817-1439
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401003658 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194307200000",
"number": "1154501229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 N SHIAWASSEE ST",
"address_2": "BOX 129",
"city": "CORUNNA",
"state": "MI",
"postal_code": "488171439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 N SHIAWASSEE ST",
"address_2": "BOX 129",
"city": "CORUNNA",
"state": "MI",
"postal_code": "488171439",
"telephone_number": "989-743-1007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROADWELL",
"first_name": "ROBERT",
"credential": "MA, LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-11-06",
"last_updated": "2007-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401003658",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corunna, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.