CARLY BROADHEAD (NPI# 1275975914) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275975914 |
| Entity Type | Individual |
| Full Name | CARLY BROADHEAD |
| Credential | MA, NCC, LPC |
| Practice Address |
3071 E Franklin Rd Ste 201 Meridian ID 83642 |
| Mailing Address |
11828 W Fairview Ave Apt 202 Boise ID 83713-7802 |
| Practice Telephone | 2088072877 |
| Mailing Telephone | 9862009268 |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2019-03-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | MH3237 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 11828 W Fairview Ave Apt 202, Boise, ID 837137802 | 9862009268 | |
| 1825 Marika Rd, Fairbanks, AK 997095521 | 9074740890 | 9074743621 |
| Street Address |
3071 E FRANKLIN RD STE 201 |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730416454 | Beth Marie Christiansen | Counselor | 3071 E Franklin Rd Ste 201, Meridian, ID 83642-2376 | 2009-11-17 |
| 1487261293 | Kristin Michelle Overton | Social Worker | 3071 E Franklin Rd Ste 201, Meridian, ID 83642-2376 | 2020-09-25 |
| 1265058283 | Nicole Johnson | Counselor | 3071 E Franklin Rd Ste 201, Meridian, ID 83642-2376 | 2020-06-25 |
| 1306468814 | Tami D. Harris | Counselor | 3071 E Franklin Rd Ste 201, Meridian, ID 83642-2376 | 2020-05-07 |
| 1699335679 | Brandon J. Thomas | Social Worker | 3071 E Franklin Rd Ste 201, Meridian, ID 83642-2376 | 2019-06-20 |
| 1841702784 | Ephrain Moises Esperilla-lopez | Social Worker | 3071 E Franklin Rd Ste 201, Meridian, ID 83642-2376 | 2017-11-01 |
| 1700338092 | Ryan Levinger | Social Worker | 3071 E Franklin Rd Ste 201, Meridian, ID 83642-2376 | 2016-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| Find all providers in zip 83642 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912537317 | Courtney M Hollie | Counselor | 1054 Ms-19, Meridian, MS 39301 | 2020-01-24 |
| 1972145308 | Sarah Barnes | Counselor | 2068 S Eagle Rd, Meridian, ID 83642-6707 | 2019-10-17 |
| 1033688007 | Garrett Kroon | Counselor | 3061 S Meridian Rd Ste 100, Meridian, ID 83642-7962 | 2018-11-19 |
| 1841778131 | Rikki Victoria Clemens Jensen | Counselor | 1985 N Monaco Way, Meridian, ID 83646-1302 | 2018-07-30 |
| 1477062248 | Kristen K French | Counselor | 1887 E Summerridge Dr, Meridian, ID 83646-5587 | 2017-09-25 |
| 1821462672 | Kimberly Beck | Counselor | 39 W. Pine Ave, Meridian, ID 83642 | 2015-11-17 |
| 1598188286 | Dwyla Wilson | Counselor | 5842 Mohawk Rd, Meridian, MS 39305-1367 | 2014-01-30 |
| 1467884627 | Jennifer L Smith | Counselor | 1865 N Lakes Pl, Meridian, ID 83646-1921 | 2013-07-30 |
| 1932407319 | Michele Anne Roeder | Counselor | 39 East State Avenue, Meridian, ID 83642 | 2011-03-08 |
| 1205142106 | Sandra Denice Clark | Counselor | 5701 N Hills St, Meridian, MS 39307-2903 | 2010-08-30 |
| Find all providers in MERIDIAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.