Provider Demographics
NPI:1942727763
Name:JUNEAU, KATHERINE BROUSSARD (LCSW, BACS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BROUSSARD
Last Name:JUNEAU
Suffix:
Gender:F
Credentials:LCSW, BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:LA
Mailing Address - Zip Code:70558-0136
Mailing Address - Country:US
Mailing Address - Phone:337-789-4689
Mailing Address - Fax:
Practice Address - Street 1:317 NORA BROUSSARD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592
Practice Address - Country:US
Practice Address - Phone:337-789-4689
Practice Address - Fax:337-789-4689
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty