Provider Demographics
NPI:1316281645
Name:BROSSEAU, AMANDA LEIGH (MS, CGC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:BROSSEAU
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1713
Mailing Address - Country:US
Mailing Address - Phone:214-824-9600
Mailing Address - Fax:214-824-9601
Practice Address - Street 1:411 N WASHINGTON AVE
Practice Address - Street 2:SUITE 3300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1713
Practice Address - Country:US
Practice Address - Phone:214-824-9600
Practice Address - Fax:214-824-9601
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS