# BROUSSARD MARRIAGE & FAMILY THERAPY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285384636
- **Authorized official:** SUSAN ANN BROUSSARD LMFT (CEO)
- **Authorized official phone:** (619) 607-1234

## Contact information

- **Practice address:** 41661 ENTERPRISE CIR N STE 111, TEMECULA, CA 92590-5629
- **Practice address phone:** (619) 607-1234
- **Practice address fax:** (951) 527-1401
- **Mailing address:** 29042 SILVERDALE LN, WINCHESTER, CA 92596-9616
- **Mailing address phone:** (619) 607-1234
- **Mailing address fax:** (951) 527-1401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/28/2022
- **Last updated:** 10/24/2022