Bailey Michelle Broussard

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

011934568 Issued in LA

Practice address

1215 Independence Blvd BLDG 6
Zachary, LA 70791-7390

Phone

(225) 286-1547

NPI assigned

Sep 15, 2022

Last updated

Sep 15, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

State licenses

Practice roles

Locations

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

• Center for Autism & Related Disorders, LLC

  • Behavior Analyst
  • Peachtree City, GA
  • NPI 1689320814
  NPD
• Center for Autism and Related Disorders LLC

  dba Card

  • Behavior Analyst
  • Plano, TX
  • NPI 1669651675
  NPD

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

{
    "created_epoch": "1663200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1609598630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5850 GRANITE PKWY STE 600",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750246753",
            "telephone_number": "469-694-1754",
            "fax_number": "818-758-8015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 INDEPENDENCE BLVD BLDG 6",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "707917390",
            "telephone_number": "225-286-1547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "BAILEY",
        "middle_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-15",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "LA",
            "license": "011934568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridge Builders Consultants, LLC (Bridge Builders Care Services)
• Bridges of Love, LLC
• Lisa Broadnax, MED
• Maryann Brock, PT
• Kirsten Brouillette
• Michael Broussard, PT
• Clayton G Brown, MD
• Devin Brown, M.ED., PLPC, NCC
• James Witschen Bryce II, RPH
• Sarah Robert Bueche, LOTR

• Behavior Technician in Zachary, LA
• Providers in Zachary, LA by specialty
• Behavior Technician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; 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.