| Broussard Marriage & Family Therapy Inc | |
|
41661 Enterprise Cir N Ste 111 Temecula CA 92590-5629 | |
| (619) 607-1234 | |
| (951) 527-1401 |
| Full Name | Broussard Marriage & Family Therapy Inc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 41661 Enterprise Cir N Ste 111, Temecula, California |
| Authorized Official Name and Position | Susan Ann Broussard (CEO) |
| Authorized Official Contact | 6196071234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broussard Marriage & Family Therapy Inc 29042 Silverdale Ln Winchester CA 92596-9616 Ph: (619) 607-1234 | Broussard Marriage & Family Therapy Inc 41661 Enterprise Cir N Ste 111 Temecula CA 92590-5629 Ph: (619) 607-1234 |
| NPI Number | 1285384636 |
|---|---|
| Provider Enumeration Date | 03/28/2022 |
| Last Update Date | 10/24/2022 |
| Certification Date | 10/24/2022 |
| Medicare PECOS PAC ID | 3870944713 |
|---|---|
| Medicare Enrollment ID | O20240104004341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285384636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Susan Ann Broussard |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1003946500 PECOS PAC ID: 7416308366 Enrollment ID: I20240125004195 |
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