Provider Demographics
NPI:1134823552
Name:BROCHUE, KAREN (LMFT)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:BROCHUE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:BROCHUE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2919 FORMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-3910
Mailing Address - Country:US
Mailing Address - Phone:210-857-0410
Mailing Address - Fax:
Practice Address - Street 1:2919 FORMOSA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-3910
Practice Address - Country:US
Practice Address - Phone:210-857-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4581106H00000X
TX4990106H00000X
FLMT4581106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist