Clay Burt Broadwell
Community/Behavioral Health in Bismarck, ND. Individual provider (NPI-1).
NPI number1225868797
StatusActive
Last updated in NPPESAug 7, 2024
Details
- NPI
- 1225868797
- Entity type
- Individual (NPI-1)
- Name
- Clay Burt Broadwell
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 7, 2024
- Certification date
- Aug 7, 2024
- Last updated
- Aug 7, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Practice location
2130 S 12th St Apt 137Bismarck, ND 58504-3144
Phone 701-840-1506
Mailing address
2130 S 12th St Apt 137Bismarck, ND 58504-3144
Phone 701-840-1506
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