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General NPI Number Information
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NPI Number | 1124978457
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Entity Type | Individual
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Provider Name | ALLYSON IRENE BROADSTREET LMHC
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Gender | Female
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Dates
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Enumeration Date | 01/28/2026
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 11988 FISHERS CROSSING DR STE 100
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City | FISHERS
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State | IN
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Zip | 46038-2707
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Country | US
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Telephone | 317-372-2267
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Fax |
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Provider Business Mailing Address
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Address Line | 9912 W HAVEN CIR APT H
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City | CARMEL
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State | IN
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Zip | 46280-2801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39005864A
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License Number State | IN
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