Justin Tyler Broussard, is a
Counselor - Mental Health based in San Louis Obispo, California. Justin Tyler Broussard is licensed to practice in * (Not Available) (license number ) and his current practice location is
3765 S. Higuera, Suite 100, San Louis Obispo, California. He can be reached at his office (for appointments etc.) via phone at
(805) 781-3535.
NPI number for Justin Tyler Broussard is 1326310632 and his current mailing address is 1750 Prefumo Canyon Rd, San Louis Obispo, California. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1326310632.
Healthcare Provider's Profile
| Full Name | Justin Tyler Broussard |
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| Gender | Male |
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| Speciality | Counselor - Mental Health |
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| Location | 3765 S. Higuera, San Louis Obispo, California |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1326310632
- Provider Enumeration Date: 02/01/2012
- Last Update Date: 01/27/2014
Medical Identifiers
Medical identifiers for Justin Tyler Broussard such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1326310632 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Justin Tyler Broussard is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Justin Tyler Broussard,
1750 Prefumo Canyon Rd,
San Louis Obispo, CA 93405
Ph: (805) 781-3535 | Justin Tyler Broussard,
3765 S. Higuera, Suite 100,
San Louis Obispo, CA 93401
Ph: (805) 781-3535 |
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