Provider Demographics
NPI:1548349848
Name:BROECKER, JAMES HAROLD (MS, LMFT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HAROLD
Last Name:BROECKER
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 644
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-0644
Mailing Address - Country:US
Mailing Address - Phone:715-531-6760
Mailing Address - Fax:715-531-6761
Practice Address - Street 1:401 STAGELINE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-7897
Practice Address - Country:US
Practice Address - Phone:715-531-6760
Practice Address - Fax:715-531-6761
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI650-124106H00000X
MN913106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist