Bailey Michelle Broussard
Individual provider Active NPI Behavior Technician · Zachary, LA
NPI 1609598630 · NPPES record last updated Sep 15, 2022
Key facts
- NPI
- 1609598630
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- 011934568 (LA)
- Practice address
- 1215 Independence Blvd BLDG 6
Zachary, LA 70791-7390 - Phone
- (225) 286-1547
- NPI assigned
- Sep 15, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
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 |
|---|---|---|---|
| 011934568 | LA | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Autism & Related Disorders, LLC | Current |
Accepting new patients | |
| Center for Autism and Related Disorders LLC | Current |
Accepting new patients |
Locations
5850 Granite Pkwy
Ste 600
Plano, TX 75024
Phone (442) 325-3819
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 011934568 | LA | Yes |
Addresses
Primary practice location
1215 Independence Blvd BLDG 6
Zachary, LA 70791-7390
Mailing address
5850 Granite Pkwy Ste 600
Plano, TX 75024-6753
Phone (469) 694-1754
Other providers in Zachary, LA
- Bridges of Love, LLC
- Lisa Broadnax
- Maryann Brock
- Camryn Brouillette
- Kirsten Brouillette
- Michael Broussard
- Clayton G Brown
- Devin Brown
- James Witschen Bryce II
- Sarah Robert Bueche
All providers in Zachary, LA · Behavior Technician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2022. 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.