MEDICARE: MICHAEL DORWIN BROADNAX II TLMFT

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	101YM0800X	Mental Health Counselor	2860	TN

General Provider Information

NPI Number	:	1528922283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DORWIN BROADNAX II TLMFT

Provider Business Mailing Address
First Line	:	909 MEADOWLARK LN
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-2309
Country	:	US
Telephone Number	:	615-756-4898
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 MEADOWLARK LN
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-2309
Country	:	US
Telephone Number	:	615-756-4898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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