| Doctor Name: | TAMMY BROUSSARD |
| NPI Number: | 1225233646 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., LPC |
| License Number: | 3781 |
| Business Practice Address: | 204 E Choctaw Ave Sallisaw, OK - 749554604 |
| Business Phone Number: | 9187902292 |
| Business Fax Number: | 9187902291 |
| Mailing Address: | 204 E Choctaw Ave, SALLISAW |
| State: | OK |
| Postal Code: | 749554604 |
| Phone Number: | 9187902292 |
| Fax Number: | 9187902291 |
| NPI Enumeration Date: | 06/16/2007 |
| NPI Last Update Date: | 07/16/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 3781 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |