Active NPI
Kelly Michelle Broussard, LMHC
- Mental Health Counselor
- Hilo, HI
National Provider Identifier
1871050146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MHC-790
- Practice address
- 190 Keawe St Ste 33
Hilo, HI 96720-2849 - Phone
- (808) 238-9990
- NPI assigned
- Feb 22, 2019
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MHC-790 | HI | Primary |
Addresses
Primary practice location
190 Keawe St Ste 33
Hilo, HI 96720-2849
Mailing address
7006 W Briarwood Ave
Wichita, KS 67212-2928
Phone (808) 238-9990
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MHC-790 | HI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727913600000",
"number": "1871050146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7006 W BRIARWOOD AVE",
"city": "WICHITA",
"state": "KS",
"postal_code": "672122928",
"telephone_number": "808-238-9990",
"fax_number": "808-865-2930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 KEAWE ST STE 33",
"city": "HILO",
"state": "HI",
"postal_code": "967202849",
"telephone_number": "808-238-9990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "KELLY",
"middle_name": "MICHELLE",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-22",
"last_updated": "2024-10-03",
"certification_date": "2024-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "HI",
"license": "MHC-790",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hilo, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.