MEDICARE: DANIEL T BROUGHTON INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1144041567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL T BROUGHTON INC

Provider Business Mailing Address
First Line	:	435 TIMBERWOOD TRL
Second Line	:
City	:	ORTONVILLE
State	:	MI
Zip	:	48462-8645
Country	:	US
Telephone Number	:	810-869-1015
Fax Number	:	810-535-5125

Provider Business Practice Location Address
First Line	:	8323 OFFICE PARK DR STE C-3
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2068
Country	:	US
Telephone Number	:	810-869-1015
Fax Number	:	810-535-5125

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL T BROUGHTON
Credential	:
Telephone Number	:	810-869-1015

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	10/18/2024

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