MEDICARE: ANDREA BROADWATER LMHC, CMHS, MHP, LPC

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	MC60393707	WA

General Provider Information

NPI Number	:	1679946818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA BROADWATER LMHC, CMHS, MHP, LPC

Provider Business Mailing Address
First Line	:	4518 CASHMERE DR NE
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98516-1356
Country	:	US
Telephone Number	:	734-210-0308
Fax Number	:

Provider Business Practice Location Address
First Line	:	2232 S MAIN ST # 384
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-6938
Country	:	US
Telephone Number	:	734-210-0308
Fax Number	:

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

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	09/12/2024

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