Provider Demographics
NPI:1932323516
Name:BROZIK, KAREN L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:BROZIK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7996
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0116
Mailing Address - Country:US
Mailing Address - Phone:928-671-0077
Mailing Address - Fax:
Practice Address - Street 1:12600 N 113TH AVE
Practice Address - Street 2:SUITE C-19
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1162
Practice Address - Country:US
Practice Address - Phone:928-617-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11742101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ886799Medicaid
AZ7071001OtherVALUE OPTIONS