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Ricky Lee Broughton, PRSS
Peer Specialist in Logan, West Virginia
NPI 1639806227

Ricky Lee Broughton is a Peer Specialist based in Logan, WV. Ricky Lee Broughton practices in Logan, WV and has the professional credentials of PRSS. The NPI Number for Ricky Lee Broughton is 1639806227 and holds a License No. 21-818 (West Virginia).

The current practice location address for Ricky Lee Broughton is 1112 Enterprise Drive, Logan, WV and can be reached out via phone at 304-896-6871.

Location: 1112 Enterprise Drive, Logan, WV, 25601
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1639806227
Provider Name
Ricky Lee Broughton
Credential
PRSS
Provider Entity Type
Individual
Gender
Male
Address
1112 Enterprise Drive, Logan, WV, 25601
Phone Number
304-896-6871
Fax Number
Provider Enumeration Date
08/03/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1112 Enterprise Drive
City
Logan
State
West Virginia
Zip
25601
Phone Number
304-896-6871
Fax Number
person
Provider Business Mailing Address Details
Address
1112 Enterprise Drive
City
Logan
State
West Virginia
Zip
25601
Phone Number
304-896-6871
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
21-818 (West Virginia)
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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