Provider Demographics
NPI:1114150307
Name:BROOME, JOSEPH EDWARD (MA, LMHC, CMHS, EMHS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:BROOME
Suffix:
Gender:M
Credentials:MA, LMHC, CMHS, EMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WELLS AVE S UNIT A
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2786
Mailing Address - Country:US
Mailing Address - Phone:206-295-0624
Mailing Address - Fax:888-274-5277
Practice Address - Street 1:306 WELLS AVE S UNIT A
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:206-295-0624
Practice Address - Fax:888-274-5277
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60200686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health