Individual
BRODERICK HUNTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
254 OLYMPIA DR, SHREVEPORT, LA 71106
(318) 918-9363
Mailing address
254 OLYMPIA DR, SHREVEPORT, LA 71106-7557
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
LA
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
Other
Enumeration date
12/21/2015
Last updated
08/21/2018
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