Individual provider Active NPI

Jessica Broussard Baudoin, PH.D., LMFT, LPC

  • Marriage & Family Therapist
  • Lafayette, LA
National Provider Identifier
1861794729
Registry record updated Nov 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
1138 Issued in LA
Practice address
4540 Ambassador Caffery Pkwy
Building D, Suite B-220
Lafayette, LA 70508-6928
Phone
(337) 981-2180
Fax
(337) 981-2391
NPI assigned
Nov 29, 2010
Last updated
Nov 29, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 1138 LA Primary
Counselor 101Y00000X 4042 LA

Addresses

Primary practice location

4540 Ambassador Caffery Pkwy
Building D, Suite B-220
Lafayette, LA 70508-6928

Mailing address

3936 Olias Rd
Erath, LA 70533-6351

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1138LAMDMarriage & Family Therapist
4042LAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1290988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290988800000",
    "number": "1861794729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3936 OLIAS RD",
            "city": "ERATH",
            "state": "LA",
            "postal_code": "705336351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 AMBASSADOR CAFFERY PKWY",
            "address_2": "BUILDING D, SUITE B-220",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086928",
            "telephone_number": "337-981-2180",
            "fax_number": "337-981-2391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUDOIN",
        "first_name": "JESSICA",
        "middle_name": "BROUSSARD",
        "credential": "PH.D., LMFT, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-29",
        "last_updated": "2010-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "LA",
            "license": "1138",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "LA",
            "license": "4042",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2010; 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.