Provider Demographics
NPI:1952551954
Name:BROADUS, KAREN A (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:A
Last Name:BROADUS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:MAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:632 W GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5169
Mailing Address - Country:US
Mailing Address - Phone:530-666-1631
Mailing Address - Fax:530-661-9969
Practice Address - Street 1:632 W GIBSON RD
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-5169
Practice Address - Country:US
Practice Address - Phone:530-666-1631
Practice Address - Fax:530-661-9969
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60670106H00000X
CALMFT53698101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist