Healthcare Provider Details

I. General information

NPI: 1720209570
Provider Name (Legal Business Name): KAREN K. BROADWELL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 BLUE LAKE CIRCLE SUITE 134
DALLAS TX
75244
US

IV. Provider business mailing address

3609 GRANBURY DR
DALLAS TX
75287-4930
US

V. Phone/Fax

Practice location:
  • Phone: 972-407-6838
  • Fax:
Mailing address:
  • Phone: 972-862-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number03435
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: