Individual
SHACURIOUS T BROADUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
800 TEXAS ST, VIDALIA, LA 71373-3239
(985) 422-5592
(985) 422-5592
Mailing address
1112 PALM ST, VIDALIA, LA 71373-3837
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
2687769
LA
Other
Enumeration date
08/07/2026
Last updated
08/07/2026
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