Provider Demographics
NPI:1235261751
Name:BRODICH, MILLIE (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:MILLIE
Middle Name:
Last Name:BRODICH
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 TROUBLE CREEK RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4922
Mailing Address - Country:US
Mailing Address - Phone:727-842-3506
Mailing Address - Fax:727-842-2050
Practice Address - Street 1:5006 TROUBLE CREEK RD
Practice Address - Street 2:SUITE 222
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4922
Practice Address - Country:US
Practice Address - Phone:727-842-3506
Practice Address - Fax:727-842-2050
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8358101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional