Shannon Marie Broussard-Bueno, LAC
Individual provider Active NPI Mental Health Counselor · Portland, OR
NPI 1386430692 · NPPES record last updated May 19, 2025
Key facts
- NPI
- 1386430692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- R10988 (OR)
- Practice address
- 5441 S Macadam Ave Ste 4561
Portland, OR 97239-6106 - Phone
- (337) 717-0401
- NPI assigned
- Apr 15, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R10988 | OR | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | R10988 | OR | Yes |
Addresses
Primary practice location
5441 S Macadam Ave Ste 4561
Portland, OR 97239-6106
Mailing address
5441 S Macadam Ave Ste 4561
Portland, OR 97239-6106
Phone (337) 717-0401
Other providers in Portland, OR
- Evelyn M Brosnan
- Michael Brosnan
- John Paul Brotzman
- Danielle Alison Brouillard
- Adam Packard Brounstein
- Marlon Joseph Broussard
- Stephanie Broussard
- William Fred Broussard
- Jordan Brower
- Julianne Brower
All providers in Portland, OR · Mental Health Counselor in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.