Provider Demographics
NPI:1942690870
Name:BROBST, JULIE (LAC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BROBST
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SW MEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3147
Mailing Address - Country:US
Mailing Address - Phone:785-233-0666
Mailing Address - Fax:785-233-8065
Practice Address - Street 1:1701 SW MEDFORD AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3147
Practice Address - Country:US
Practice Address - Phone:785-233-0666
Practice Address - Fax:785-233-8065
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS698324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100322140AMedicaid