Keitha Latrice Broyles
Individual provider Active NPI Mental Health Counselor · Millington, TN
NPI 1649792128 · NPPES record last updated Jul 17, 2017
Key facts
- NPI
- 1649792128
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 5281 Navy Rd
Millington, TN 38053-2535 - Phone
- (901) 873-0305
- NPI assigned
- Jul 17, 2017
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
5281 Navy Rd
Millington, TN 38053-2535
Mailing address
4375 Highway 51 N Apt 25-103
Horn Lake, MS 38637-8720
Phone (901) 371-7185
Other providers in Millington, TN
- Bolland Dental PLLC
- Ramona Boswell
- Branch Medical Clinic Mid-South
- Heather Shawn Brasfield
- David Brick
- Sherry Buckley-Clayton
- Maria Burke
- Mary Ann Burns
- Robin Burris
- Elizabeth Calabretta
All providers in Millington, TN · Mental Health Counselor in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2017. 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.