Provider Demographics
NPI:1326780347
Name:BROUSSARD, PATRICIA S (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26411 OAK RIDGE DR # 9
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1964
Mailing Address - Country:US
Mailing Address - Phone:936-287-3518
Mailing Address - Fax:
Practice Address - Street 1:26411 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-1964
Practice Address - Country:US
Practice Address - Phone:936-287-3518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist