Provider Demographics
NPI:1821218207
Name:BROUGH, DAVID V (LMHC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:V
Last Name:BROUGH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 N PINE MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-9245
Mailing Address - Country:US
Mailing Address - Phone:509-465-0209
Mailing Address - Fax:
Practice Address - Street 1:100 N MULLAN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6848
Practice Address - Country:US
Practice Address - Phone:509-926-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health