MEDICARE: DEONTE BROUSSARD LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1376947101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEONTE BROUSSARD LPC

Provider Business Mailing Address
First Line	:	6022 BELNEATH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-1222
Country	:	US
Telephone Number	:	832-689-9460
Fax Number	:

Provider Business Practice Location Address
First Line	:	6022 BELNEATH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-1222
Country	:	US
Telephone Number	:	832-689-9460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2014
Last Update Date	:	10/22/2014

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Directions to “ DEONTE BROUSSARD LPC” Practice Location

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