Provider Demographics
NPI:1326596289
Name:BROUSSARD, JARED MORGAN (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:MORGAN
Last Name:BROUSSARD
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16835 AMELIA ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3492
Mailing Address - Country:US
Mailing Address - Phone:281-782-4314
Mailing Address - Fax:
Practice Address - Street 1:13602 JARVIS RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-3802
Practice Address - Country:US
Practice Address - Phone:832-303-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health