Provider Demographics
NPI:1437956745
Name:BROUSSARD, CHRISTINE (MA, CADC-I)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:MA, CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230356
Mailing Address - Street 2:12210 SW MAIN ST
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6222
Mailing Address - Country:US
Mailing Address - Phone:971-249-2440
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 230356
Practice Address - Street 2:12210 SW MAIN ST
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6222
Practice Address - Country:US
Practice Address - Phone:971-249-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR250111375101YA0400X
ORR10584101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)