Provider Demographics
NPI:1154037000
Name:BROOME, RICHARD ALLEN (BS LAC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALLEN
Last Name:BROOME
Suffix:
Gender:M
Credentials:BS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 FRANKLIN RD STE 430
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1602
Mailing Address - Country:US
Mailing Address - Phone:615-751-0579
Mailing Address - Fax:
Practice Address - Street 1:8202 CLEARVISTA PKWY STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1400
Practice Address - Country:US
Practice Address - Phone:317-623-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000289A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor