Active NPI
Rachel Brousseau
- Counselor
- Burbank, CA
National Provider Identifier
1639429954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 628 S San Fernando Blvd
Burbank, CA 91502-1442 - Phone
- (626) 460-0570
- NPI assigned
- Sep 13, 2012
- Last updated
- Mar 17, 2018
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | NU | Primary |
Addresses
Primary practice location
628 S San Fernando Blvd
Burbank, CA 91502-1442
Mailing address
628 S San Fernando Blvd
Burbank, CA 91502-1442
Phone (626) 460-0570
Other practice location 1
5849 Crocker St
Los Angeles, CA 90003-1311
Phone (323) 234-4445 ext. 100
Other practice location 2
5849 Crocker St
Los Angeles, CA 90003-1311
Phone (323) 234-4445 ext. 100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Special Service for Groups, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Adolescent and Children Mental Health Clinic/Center
- Los Angeles, CA
- NPI 1982735932
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1639429954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "628 S SAN FERNANDO BLVD",
"city": "BURBANK",
"state": "CA",
"postal_code": "915021442",
"telephone_number": "626-460-0570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "628 S SAN FERNANDO BLVD",
"city": "BURBANK",
"state": "CA",
"postal_code": "915021442",
"telephone_number": "626-460-0570"
}
],
"practiceLocations": [
{
"address_1": "5849 Crocker St",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900031311",
"country_code": "US",
"telephone_number": "323-234-4445 x100",
"fax_number": "323-234-4477",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5849 Crocker St",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900031311",
"country_code": "US",
"telephone_number": "323-234-4445 x100",
"fax_number": "323-234-4477",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BROUSSEAU",
"first_name": "RACHEL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-13",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burbank, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.