Provider Demographics
NPI:1619191418
Name:BROUSSARD HARGRAVE & SHEA LLC
Entity Type:Organization
Organization Name:BROUSSARD HARGRAVE & SHEA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LMFT NCC
Authorized Official - Phone:337-365-7575
Mailing Address - Street 1:PO BOX 9685
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562
Mailing Address - Country:US
Mailing Address - Phone:337-365-7575
Mailing Address - Fax:337-365-7878
Practice Address - Street 1:203 WEST MAIN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560
Practice Address - Country:US
Practice Address - Phone:337-365-7575
Practice Address - Fax:337-365-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CS68Medicare ID - Type Unspecified