Provider Demographics
NPI:1023500071
Name:BROUSSARD, RANDALL PAUL II
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:PAUL
Last Name:BROUSSARD
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 MAPLEWOOD DR APT 1
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6359
Mailing Address - Country:US
Mailing Address - Phone:337-853-5442
Mailing Address - Fax:
Practice Address - Street 1:3905 MAPLEWOOD DR APT 1
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-6359
Practice Address - Country:US
Practice Address - Phone:337-853-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor