Provider Demographics
NPI:1023676913
Name:BROADRIGHT COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:BROADRIGHT COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:BROADRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:719-685-6729
Mailing Address - Street 1:1403 FANTAIL LANE
Mailing Address - Street 2:FANTAIL LANE
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-6968
Mailing Address - Country:US
Mailing Address - Phone:719-685-6729
Mailing Address - Fax:
Practice Address - Street 1:1403 FANTAIL LANE
Practice Address - Street 2:FANTAIL LANE
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-6968
Practice Address - Country:US
Practice Address - Phone:719-685-6729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO103TC1900XMedicaid