Broadway, Letta
Broadway, Letta is an individual health care provider with primary practice located at 801 N Air Depot Blvd , Midwest City OK 73110. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Broadway, Letta can be contacted via phone (405) 733-9516.Contact Information
Primary practice address
801 N Air Depot Blvd
Midwest City OK 73110
Phone: (405) 733-9516
Fax: (405) 733-8853
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 1656 | Oklahoma |
Profile Details
| NPI number | 1235107483 |
|---|---|
| LBN Legal business name | Broadway, Letta |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 14th, 2006 |
| Last updated | Jul 21st, 2010 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1235107483 | NPPES |
| Oklahoma | MEDICAID | 100716230B |
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