1417421017 NPI number — MRS. CHRISTINE BROUSSARD RODRIGUE MA, LPC

Table of content: MRS. CHRISTINE BROUSSARD RODRIGUE MA, LPC (NPI 1417421017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417421017 NPI number — MRS. CHRISTINE BROUSSARD RODRIGUE MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUE
Provider First Name:
CHRISTINE
Provider Middle Name:
BROUSSARD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUSANG
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
BROUSSARD
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417421017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4728 JEFFERSON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-236-6007
Provider Business Mailing Address Fax Number:
504-734-3707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4728 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-236-6007
Provider Business Practice Location Address Fax Number:
504-734-3707
Provider Enumeration Date:
01/16/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  7956 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com