Mark Shannon Broussard, LAC, CCS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

661 Issued in LA

Practice address

5431 Superior Dr
Baton Rouge, LA 70816-6044

Phone

(225) 964-5000

NPI assigned

Mar 1, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519862400000",
    "number": "1255833661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6421 PERKINS RD STE A",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708086200",
            "telephone_number": "225-924-3000",
            "fax_number": "225-924-3030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5431 SUPERIOR DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708166044",
            "telephone_number": "225-964-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "MARK",
        "middle_name": "SHANNON",
        "credential": "LAC, CCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-01",
        "last_updated": "2018-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "LA",
            "license": "661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kennedy Broussard, LMSW
• Kristen Files Broussard, FNP-C
• Kristy Smith Broussard, NNP
• Lauren Causey Broussard, NP
• Malcolm J Broussard
• Martha A Broussard, CRNA
• Melissa Randall Broussard, MSW, LCSW
• Morgan Bankston Broussard, M.D.
• Peggy Broussard, LPC
• Ranisa Washington Broussard

• Addiction (Substance Use Disorder) Counselor in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Addiction (Substance Use Disorder) Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.