Provider Demographics
NPI:1326655515
Name:BROYLES, THOMAS EDWIN (LPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWIN
Last Name:BROYLES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 ARIAL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-7340
Mailing Address - Country:US
Mailing Address - Phone:512-953-5954
Mailing Address - Fax:
Practice Address - Street 1:313 E ANDERSON LN STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1236
Practice Address - Country:US
Practice Address - Phone:512-961-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84236101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor