Provider Demographics
NPI:1134948508
Name:BETH M BROOM, LLC
Entity type:Organization
Organization Name:BETH M BROOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROOM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:214-288-3379
Mailing Address - Street 1:4717 REDBUD DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6845
Mailing Address - Country:US
Mailing Address - Phone:214-288-3379
Mailing Address - Fax:
Practice Address - Street 1:4717 REDBUD DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6845
Practice Address - Country:US
Practice Address - Phone:214-288-3379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETH M BROOM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty