Broussard, Tammy
Broussard, Tammy is an sole proprietor health care provider with primary practice located at 204 E Choctaw Ave , Sallisaw OK 74955-4604. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Broussard, Tammy can be contacted via phone (918) 790-2292.Contact Information
Primary practice address
204 E Choctaw Ave
Sallisaw OK 74955-4604
Phone: (918) 790-2292
Fax: (918) 790-2291
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 3781 | Oklahoma |
Profile Details
| NPI number | 1225233646 |
|---|---|
| LBN Legal business name | Broussard, Tammy |
| Credentials | M.S., LPC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 16th, 2007 |
| Last updated | Jul 16th, 2012 - about 12 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225233646 | NPPES |
| Oklahoma | MEDICAID | 200350940A | |
| Oklahoma | Other | 12163359 |
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