Alexandrea Mae Broussard

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

9273 Issued in LA

Practice address

1202 Kirkman St Ste C
Lake Charles, LA 70601-5391

Phone

(337) 990-5305

Fax

(337) 990-5306

NPI assigned

Dec 7, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Fairway Counseling Agency, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Alexandria, LA
  • NPI 1912281031
  NPD (past)

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

{
    "created_epoch": "1638835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1619635612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 KIRKMAN ST STE C",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015391",
            "telephone_number": "337-990-5305",
            "fax_number": "337-990-5306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 KIRKMAN ST STE C",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015391",
            "telephone_number": "337-990-5305",
            "fax_number": "337-990-5306"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "710 Versailles Blvd",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "LA",
            "postal_code": "713032351",
            "country_code": "US",
            "telephone_number": "318-449-4474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "ALEXANDREA",
        "middle_name": "MAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-07",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "LA",
            "license": "PLC9273",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "LA",
            "license": "PLC9273",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "9273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Earl Brooks, CRNA
• Sonya M Brooks, MA CCS SLP
• Brothers Health Solutions LLC
• Brothers Pharmacy LLC
• Adrian Cale Brouillette, PMHNP-BC
• Brandon Joseph Broussard, DPT
• Britni Broussard, MS
• Craig V Broussard, MD
• Dania Broussard, MHP
• Elizabeth Marie Broussard, RN

• Professional Counselor in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Professional Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; 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.