Individual provider · Type 1 NPI
Justin Tyler Broussard
Mental Health Counselor · San Louis Obispo, CA
NPI number
1326310632
Active
Practice location
3765 S. Higuera, Suite 100
San Louis Obispo, CA 93401
Fax (805) 503-6499
Mailing address
1750 Prefumo Canyon Rd
San Louis Obispo, CA 93405
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Counselor Primary | 101YM0800X | None listed |
Mental Health Counselor: Definition to come...
3 other providers at this address
- Brianna BiberstonAddiction (Substance Use Disorder) Counselor San Luis Obispo, CA NPI 1164688420
- Meagan Elizabeth KirschMarriage & Family Therapist San Luis Obispo, CA NPI 1407126154
- Terence Michael DeverStudent in an Organized Health Care Education/Training Program San Luis Obispo, CA NPI 1255465464
About NPI 1326310632
Justin Tyler Broussard's National Provider Identifier is 1326310632, issued on Feb 1, 2012. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in San Louis Obispo, CA. The record was last updated on Jan 27, 2014.