| Doctor Name: | JACQUELYN JOY BROADUS |
| NPI Number: | 1346673506 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | MH11967 |
| Business Practice Address: | 3686 Us Highway 331 S Defuniak Springs, FL - 324358463 |
| Business Phone Number: | 8508928055 |
| Business Fax Number: | 8508928057 |
| Mailing Address: | 3686 Us Highway 331 S, DEFUNIAK SPRINGS |
| State: | FL |
| Postal Code: | 324358463 |
| Phone Number: | 8508928055 |
| Fax Number: | 8508928057 |
| NPI Enumeration Date: | 08/12/2013 |
| NPI Last Update Date: | 08/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH11967 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |