Provider Demographics
NPI:1376947101
Name:BROUSSARD, DEONTE (LPC)
Entity Type:Individual
Prefix:
First Name:DEONTE
Middle Name:
Last Name:BROUSSARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6022 BELNEATH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033-1222
Mailing Address - Country:US
Mailing Address - Phone:832-689-9460
Mailing Address - Fax:
Practice Address - Street 1:6022 BELNEATH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-1222
Practice Address - Country:US
Practice Address - Phone:832-689-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional