Latasha Broomfield, MA, LPC, NCC, CACI

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6126 Issued in SC

Practice address

409 Simpkins St
Edgefield, SC 29824-1313

Phone

(803) 637-5788

NPI assigned

Mar 24, 2014

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

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• South Carolina Dept of Mental Health Accounting Office

  • Primary Care Nurse Practitioner
  • Bennettsville, SC
  • NPI 1295332690

  SC

  Medicare reassignment NPD
• South Carolina Dept of Mental Health Accounting Office

  • Community/Behavioral Health Agency
  • Columbia, SC
  • NPI 1083421994
  NPD
• South Carolina Dept of Mental Health Accounting Office

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Spartanburg, SC
  • NPI 1427168889
  NPD
• South Carolina Dept of Mental Health Accounting Office

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Greenwood, SC
  • NPI 1124135009
  NPD (past)

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

{
    "created_epoch": "1395619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481068800000",
    "number": "1699192096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 SIMPKINS ST",
            "city": "EDGEFIELD",
            "state": "SC",
            "postal_code": "298241313",
            "telephone_number": "803-637-5788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 SIMPKINS ST",
            "city": "EDGEFIELD",
            "state": "SC",
            "postal_code": "298241313",
            "telephone_number": "803-637-5788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOMFIELD",
        "first_name": "LATASHA",
        "credential": "MA, LPC, NCC, CACI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-24",
        "last_updated": "2016-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "6126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "421504",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amara LLC
• Apsf Seniors Business Group LLP
• Banks Pharmacy
• Blocker & Timmerman Drug Co.,Inc.
• Rex Blocker, M.D.
• William C. Bruker Jr., M.D.
• Ransom L. Bryan Jr.
• Tannor Allen Byrd, DMD
• Givonia Callaham
• Jack Russell Cannon II, M.D.

• All providers in Edgefield, SC
• Professional Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.