Jacquelyn Joy Broadus, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH11967 Issued in FL

Practice address

3686 US Highway 331 S
Defuniak Springs, FL 32435-8463

Phone

(850) 892-8055

Fax

(850) 892-8057

NPI assigned

Aug 12, 2013

Last updated

Aug 12, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Sep 18, 2024 through Sep 18, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376265600000",
    "number": "1346673506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3686 US HIGHWAY 331 S",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324358463",
            "telephone_number": "850-892-8055",
            "fax_number": "850-892-8057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3686 US HIGHWAY 331 S",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324358463",
            "telephone_number": "850-892-8055",
            "fax_number": "850-892-8057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADUS",
        "first_name": "JACQUELYN",
        "middle_name": "JOY",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-12",
        "last_updated": "2013-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH11967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISON OF MEDICAL QUALITY ASSURANCE",
            "identifier": "MH11967",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Defuniak Springs, FL
• Providers in Defuniak Springs, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.