Provider Demographics
NPI:1669890869
Name:BROADIE, NATASHA
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:BROADIE
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 1:302 HUDSON PL
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7755
Mailing Address - Country:US
Mailing Address - Phone:405-774-2562
Mailing Address - Fax:
Practice Address - Street 1:302 HUDSON PL
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7755
Practice Address - Country:US
Practice Address - Phone:405-774-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health