Provider Demographics
NPI:1225246531
Name:BROUSSARD, SCOTT PATRICK
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:PATRICK
Last Name:BROUSSARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 WILLAMETTE STREET
Mailing Address - Street 2:SUITES 201 AND 202
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:541-234-3090
Mailing Address - Fax:
Practice Address - Street 1:2440 WILLAMETTE STREET
Practice Address - Street 2:SUITES 201 AND 202
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405
Practice Address - Country:US
Practice Address - Phone:541-234-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional