Active NPI
Charles Stewart Broussard, LAC
- Addiction (Substance Use Disorder) Counselor
- Lafayette, LA
National Provider Identifier
1073969218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 104
- Practice address
- 2020 W Pinhook Rd
Suite 402
Lafayette, LA 70508-3290 - Phone
- (337) 781-6467
- NPI assigned
- May 6, 2016
- Last updated
- May 6, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 104 | LA | Primary |
Addresses
Primary practice location
2020 W Pinhook Rd
Suite 402
Lafayette, LA 70508-3290
Mailing address
2020 W Pinhook Rd
Suite 402
Lafayette, LA 70508-3290
Phone (337) 781-6467
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104 | LA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462492800000",
"number": "1073969218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 W PINHOOK RD",
"address_2": "SUITE 402",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705083290",
"telephone_number": "337-781-6467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2020 W PINHOOK RD",
"address_2": "SUITE 402",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705083290",
"telephone_number": "337-781-6467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "CHARLES",
"middle_name": "STEWART",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-06",
"last_updated": "2016-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "LA",
"license": "104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.