Healthcare Provider Details

I. General information

NPI: 1225246531
Provider Name (Legal Business Name): MR. SCOTT PATRICK BROUSSARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 WILLAMETTE STREET SUITES 201 AND 202
EUGENE OR
97405
US

IV. Provider business mailing address

2440 WILLAMETTE STREET SUITES 201 AND 202
EUGENE OR
97405
US

V. Phone/Fax

Practice location:
  • Phone: 541-234-3090
  • Fax:
Mailing address:
  • Phone: 541-234-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: