1811286727 NPI number — APRIL M BROUSSARD LCSW

Table of content: APRIL M BROUSSARD LCSW (NPI 1811286727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811286727 NPI number — APRIL M BROUSSARD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROUSSARD
Provider First Name:
APRIL
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811286727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1502 AULDRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHRISTIANA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37037-6622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-427-2997
Provider Business Mailing Address Fax Number:
615-494-1145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
567 CASON LN
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37128-4821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-680-9822
Provider Business Practice Location Address Fax Number:
615-494-1145
Provider Enumeration Date:
03/31/2011

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: 1041C0700X , with the licence number:  5249 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103I808289 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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