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General NPI Number Information
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NPI Number | 1982596789
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Entity Type | Organization
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Legal Business Name | BROUSSARD MENTAL HEALTH AND WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 4016 HIGHWAY 90 E STE 112
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City | BROUSSARD
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State | LA
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Zip | 70518-3548
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Country | US
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Telephone | 337-761-0727
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Fax | 337-761-1688
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Provider Business Mailing Address
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Address Line | 105 HANNA DR
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City | YOUNGSVILLE
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State | LA
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Zip | 70592-5520
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Country | US
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Telephone | 337-277-6944
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Fax | 337-761-1688
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Authorized Official
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Title or Position | OWNER
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Name | ERICKA BROUSSARD
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Credential | PMHNP, ANP-BC
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Telephone | 337-277-6944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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