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General NPI Number Information
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NPI Number | 1659244952
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Entity Type | Individual
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Provider Name | JAYCEE BROUSSARD
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Gender | Female
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 11188 FLORIDA BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70815-2012
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Country | US
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Telephone | 337-626-1916
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Fax |
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Provider Business Mailing Address
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Address Line | 19716 HAPPY ACRES LN
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City | LIVINGSTON
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State | LA
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Zip | 70754-5050
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAC-5095
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License Number State | LA
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