Carly Broadhead, MA, NCC, LPC
Individual provider Active NPI Counselor · Meridian, ID
NPI 1275975914 · NPPES record last updated Mar 7, 2019
Key facts
- NPI
- 1275975914
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 3071 E Franklin Rd Ste 201
Meridian, ID 83642 - Phone
- (208) 807-2877
- NPI assigned
- Jul 23, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
3071 E Franklin Rd Ste 201
Meridian, ID 83642
Mailing address
11828 W Fairview Ave Apt 202
Boise, ID 83713-7802
Phone (986) 200-9268
Other practice location 1
1825 Marika Rd
Fairbanks, AK 99709-5521
Phone (907) 474-0890
Other practice location 2
11828 W Fairview Ave Apt 202
Boise, ID 83713-7802
Phone (986) 200-9268
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MH3237 | Medicaid | AK |
Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.