Individual
BAILEY MICHELLE BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1215 INDEPENDENCE BLVD BLDG 6, ZACHARY, LA 70791-7390
(225) 286-1547
Mailing address
5850 GRANITE PKWY STE 600, PLANO, TX 75024-6753
(469) 694-1754
(818) 758-8015
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
011934568
LA
Other
Enumeration date
09/15/2022
Last updated
09/15/2022
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