Provider Demographics
NPI:1811286727
Name:BROUSSARD, APRIL M (LCSW)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:M
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 AULDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:TN
Mailing Address - Zip Code:37037-6622
Mailing Address - Country:US
Mailing Address - Phone:615-427-2997
Mailing Address - Fax:615-494-1145
Practice Address - Street 1:567 CASON LN
Practice Address - Street 2:SUITE A
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4821
Practice Address - Country:US
Practice Address - Phone:615-680-9822
Practice Address - Fax:615-494-1145
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I808289OtherMEDICARE PTAN