Broussard, Stacy

Broussard, Stacy is an individual health care provider with primary practice located at 103 Lewis St , Fort Walton Beach FL 32547-3142. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as her primary health care specialty. Broussard, Stacy can be contacted via phone (850) 362-6824.

Contact Information

Primary practice address
103 Lewis St Fort Walton Beach FL 32547-3142
Phone: (850) 362-6824
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 0-16-7166 Florida

Profile Details

NPI number 1194177535
LBN Legal business name Broussard, Stacy
Credentials BCABA
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2016
Last updated Jul 11th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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