Provider Demographics
NPI:1265752109
Name:BROADOUS-MILES, LINDA JEAN
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JEAN
Last Name:BROADOUS-MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W 138TH ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-3123
Mailing Address - Country:US
Mailing Address - Phone:310-537-3166
Mailing Address - Fax:
Practice Address - Street 1:1701 W 138TH ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-3123
Practice Address - Country:US
Practice Address - Phone:310-537-3166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)