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Jaytavia Broadnax
Mental Health Counselor in Palm Harbor, Florida
NPI 1255937884

Jaytavia Broadnax is a Mental Health Counselor based in Tampa, FL and is specialized in Mental Health. Jaytavia Broadnax practices in Palm Harbor, FL. The NPI Number for Jaytavia Broadnax is 1255937884 and holds a License No. (Florida).

The current practice location address for Jaytavia Broadnax is 2311 Alt 19, Palm Harbor, FL and can be reached out via phone at 630-200-4823.

Location: 2311 Alt 19, Palm Harbor, FL, 33619-5073
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1255937884
Provider Name
Jaytavia Broadnax
Credential
Provider Entity Type
Individual
Gender
Female
Address
2311 Alt 19, Palm Harbor, FL, 33619-5073
Phone Number
630-200-4823
Fax Number
Provider Enumeration Date
12/09/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1306862511 05 FL
institution
Provider Business Practice Location Address Details
Address
2311 Alt 19
City
Palm Harbor
State
Florida
Zip
34683-2631
Phone Number
630-200-4823
Fax Number
person
Provider Business Mailing Address Details
Address
2311 Alt 19
City
Palm Harbor
State
Florida
Zip
34683-2631
Phone Number
630-200-4823
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
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