Provider Demographics
NPI:1497220727
Name:BROUSSARD, RACHEL LACY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LACY
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LA RUE FRANCE STE 102
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3104
Mailing Address - Country:US
Mailing Address - Phone:337-781-4389
Mailing Address - Fax:855-299-0797
Practice Address - Street 1:200 LA RUE FRANCE STE 102
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3104
Practice Address - Country:US
Practice Address - Phone:337-781-4389
Practice Address - Fax:855-299-0797
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-13
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA87211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty