Individual provider · Type 1 NPI
Shannon Marie Broussard-Bueno, LAC
Mental Health Counselor · Portland, OR
NPI number
1386430692
Active
Practice location
5441 S Macadam Ave Ste 4561
Portland, OR 97239-6106
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Counselor Primary | 101YM0800X | R10988 (OR) |
Mental Health Counselor: Definition to come...
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About NPI 1386430692
Shannon Marie Broussard-Bueno, LAC's National Provider Identifier is 1386430692, issued on Apr 15, 2025. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Portland, OR. The record was last updated on May 19, 2025.