Active NPI
Madison Broussard-Eastland, LPC
- Mental Health Counselor
- Humble, TX
National Provider Identifier
1447083092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 85404
- Practice address
- 5726 Upper Lake Dr
Humble, TX 77346-1905 - Phone
- (346) 341-8434
- NPI assigned
- Aug 20, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 85404 | TX | Primary |
Addresses
Primary practice location
5726 Upper Lake Dr
Humble, TX 77346-1905
Mailing address
5726 Upper Lake Dr
Humble, TX 77346-1905
Phone (281) 814-0668
Other names 1
- Madison Broussard
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85404 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724112000000",
"number": "1447083092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5726 UPPER LAKE DR",
"city": "HUMBLE",
"state": "TX",
"postal_code": "773461905",
"telephone_number": "281-814-0668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5726 UPPER LAKE DR",
"city": "HUMBLE",
"state": "TX",
"postal_code": "773461905",
"telephone_number": "346-341-8434"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD-EASTLAND",
"first_name": "MADISON",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-08-20",
"last_updated": "2024-08-20",
"certification_date": "2024-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "85404",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MADISON",
"last_name": "BROUSSARD",
"credential": "LPC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Humble, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.