Provider Demographics
NPI:1811266356
Name:BRODKOWITZ, BARBARA (LMHC)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:BRODKOWITZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:BRODKOWITZ
Other - Last Name:BOOG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:2685 E HOQUIAM RD
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-9116
Mailing Address - Country:US
Mailing Address - Phone:360-637-8696
Mailing Address - Fax:
Practice Address - Street 1:403 W STATE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6139
Practice Address - Country:US
Practice Address - Phone:360-532-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60230842101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health