Provider Demographics
NPI:1053626275
Name:BROUGHTON, CAROLYN SUE (LCMFT)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:SUE
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W IRON AVE
Mailing Address - Street 2:P.O. BOX 1366
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-2563
Mailing Address - Country:US
Mailing Address - Phone:785-825-0208
Mailing Address - Fax:785-826-9708
Practice Address - Street 1:425 W IRON AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-2563
Practice Address - Country:US
Practice Address - Phone:785-825-0208
Practice Address - Fax:785-826-9708
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS114106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist