Healthcare Provider Details

I. General information

NPI: 1992219513
Provider Name (Legal Business Name): JANNA LYNN BROXSON DBH, MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD
LUKE AFB AZ
85309-1529
US

IV. Provider business mailing address

7219 N LITCHFIELD RD
LUKE AFB AZ
85309-1529
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-7579
  • Fax: 623-856-4433
Mailing address:
  • Phone: 623-856-7579
  • Fax: 623-856-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-20501
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: