Healthcare Provider Details

I. General information

NPI: 1063134237
Provider Name (Legal Business Name): BRITTANY JEAN BROUSSARD CIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY JEAN BROUSSARD SPIVEY

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 LINE AVE STE 111
SHREVEPORT LA
71101-4651
US

IV. Provider business mailing address

3414 RIVIERA ST
SHREVEPORT LA
71107-7516
US

V. Phone/Fax

Practice location:
  • Phone: 318-408-9929
  • Fax: 318-408-9937
Mailing address:
  • Phone: 318-265-4031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5154
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: