Provider Demographics
NPI:1982848818
Name:BROQUIE, JO ANN (LPC, LSSP)
Entity Type:Individual
Prefix:
First Name:JO ANN
Middle Name:
Last Name:BROQUIE
Suffix:
Gender:F
Credentials:LPC, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 COMMUNITY BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-6186
Mailing Address - Country:US
Mailing Address - Phone:903-238-9050
Mailing Address - Fax:903-238-9051
Practice Address - Street 1:107 COMMUNITY BLVD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-6186
Practice Address - Country:US
Practice Address - Phone:903-238-9050
Practice Address - Fax:903-238-9051
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional