Provider Demographics
NPI:1588018956
Name:BROYLES, JEFFREY LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LYNN
Last Name:BROYLES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 NATIONAL DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4066
Mailing Address - Country:US
Mailing Address - Phone:919-781-8370
Mailing Address - Fax:919-781-2266
Practice Address - Street 1:3725 NATIONAL DR
Practice Address - Street 2:SUITE 220
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4066
Practice Address - Country:US
Practice Address - Phone:919-781-8370
Practice Address - Fax:919-781-2266
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional