Provider Demographics
NPI:1154886075
Name:BROADWAY-BEERS, KATHERINE LYNN
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LYNN
Last Name:BROADWAY-BEERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:BROADWAY-BEERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2772 S MARTIN L KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-5345
Mailing Address - Country:US
Mailing Address - Phone:559-265-4800
Mailing Address - Fax:559-265-4823
Practice Address - Street 1:2772 S MARTIN L KING JR BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-5345
Practice Address - Country:US
Practice Address - Phone:559-265-4800
Practice Address - Fax:559-265-4823
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9035101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)