Provider Demographics
NPI:1497462337
Name:BROADNAX, DUANE C (QMHS)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:C
Last Name:BROADNAX
Suffix:
Gender:M
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 W CENTRAL AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1510
Mailing Address - Country:US
Mailing Address - Phone:419-517-7776
Mailing Address - Fax:
Practice Address - Street 1:5650 W CENTRAL AVE STE C1
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1510
Practice Address - Country:US
Practice Address - Phone:419-517-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health