| Organization Name: | DARRELL BROADDUS PSYCHOLOGICAL SERVICES PC |
| NPI Number: | 1215339650 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DARRELL BROADDUS (OWNER/OPERATOR) |
| Mailing Address: | 6128 Via Presidio Orangevale |
| State: | CA US |
| Postal Code: | 956624460 |
| Phone Number: | 9164124270 |
| Fax Number: | |
| NPI Enumeration Date: | 09/17/2014 |
| NPI Last Update Date: | 09/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |