Doctor Name: | KENYETTA N. BROUGHTON-FLOYD |
NPI Number: | 1104030139 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 201 Lester Rd Park Forest, IL - 604662013 |
Business Phone Number: | 3122389128 |
Business Fax Number: | |
Mailing Address: | Po Box 992, PARK FOREST |
State: | IL |
Postal Code: | 604660992 |
Phone Number: | 3122389128 |
Fax Number: | 7084340811 |
NPI Enumeration Date: | 05/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YS0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | School |
Taxonomy Definition: |