James Broussard, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

591036 Issued in MS

Practice address

1000 Highland Colony Pkwy Ste 5203
Ridgeland, MS 39157-2079

Phone

(601) 809-5324

NPI assigned

Aug 11, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Broussard Behavioral Health Services LLC

  • Clinical Psychologist
  • Jackson, MS
  • NPI 1841187408
  NPD Authorized official

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

{
    "created_epoch": "1313020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608163200000",
    "number": "1447539176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HIGHLAND COLONY PKWY STE 5203",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391572079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HIGHLAND COLONY PKWY STE 5203",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391572079",
            "telephone_number": "601-809-5324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-11",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MS",
            "license": "591036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; 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.