Provider Demographics
NPI:1467977488
Name:BROUSSARD, CODY PAUL (PLPC)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:PAUL
Last Name:BROUSSARD
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-5331
Mailing Address - Country:US
Mailing Address - Phone:337-824-1255
Mailing Address - Fax:
Practice Address - Street 1:203 E ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546
Practice Address - Country:US
Practice Address - Phone:337-824-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker