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General NPI Number Information
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NPI Number | 1245366210
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Entity Type | Organization
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Legal Business Name | LOWCOUNTRY EQUINE-ASSISTED PSYCHOTHERAPY
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2 WHARFSIDE ST 3F
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City | CHARLESTON
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State | SC
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Zip | 29401-1652
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Country | US
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Telephone | 843-723-0659
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Fax | 843-723-0659
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Provider Business Mailing Address
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Address Line | PO BOX 20310
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City | CHARLESTON
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State | SC
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Zip | 29413-0310
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Country | US
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Telephone | 843-723-0659
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Fax | 843-723-0659
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHLEEN G. BROUGHAN
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Credential | PH.D.
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Telephone | 843-723-0659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 437
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 501
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License Number State | SC
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