Individual
MRS. CHRISTINE BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CADC-I
Contact information
Practice address
PO BOX 230356, 12210 SW MAIN ST, TIGARD, OR 97223-6222
(971) 249-2440
Mailing address
PO BOX 230356, 12210 SW MAIN ST, TIGARD, OR 97223-6222
(971) 249-2440
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
250111375
OR
101YM0800X
Mental Health Counselor
Primary
R10584
OR
Other
Enumeration date
02/26/2025
Last updated
02/26/2025
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