Provider Demographics
NPI:1609101575
Name:BROHIMER, MARY M (MA, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:BROHIMER
Suffix:
Gender:F
Credentials:MA, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 CLAY LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-7644
Mailing Address - Country:US
Mailing Address - Phone:423-341-2035
Mailing Address - Fax:
Practice Address - Street 1:222 CLAY LITTLE RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-7644
Practice Address - Country:US
Practice Address - Phone:423-341-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC1781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516680Medicaid