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NPI Code Detail

MEDICARE: MS. MARY LEE BROUGHER RTC, CTRS

MEDICARE: MS. MARY LEE BROUGHER RTC, CTRS
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
1101YM0800XMental Health Counselor2827-TCA
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1962556985
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY LEE BROUGHER RTC, CTRS
Provider Business Mailing Address
First Line : 2121 W TEMPLE ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-4915
Country : US
Telephone Number : 213-385-5100
Fax Number :
Provider Business Practice Location Address
First Line : 2121 W TEMPLE ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-4915
Country : US
Telephone Number : 213-385-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 09/15/2020

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