Provider Demographics
NPI:1720209570
Name:BROADWELL, KAREN K (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:K
Last Name:BROADWELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 GRANBURY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4930
Mailing Address - Country:US
Mailing Address - Phone:972-862-3016
Mailing Address - Fax:
Practice Address - Street 1:4141 BLUE LAKE CIRCLE
Practice Address - Street 2:SUITE 134
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244
Practice Address - Country:US
Practice Address - Phone:972-407-6838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX034351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical