Provider Demographics
NPI:1407424674
Name:BROUSSARD, SARA E (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W MISTLETOE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3334
Mailing Address - Country:US
Mailing Address - Phone:210-262-1448
Mailing Address - Fax:
Practice Address - Street 1:4242 WOODCOCK DR STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1325
Practice Address - Country:US
Practice Address - Phone:210-481-8673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional