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NPI Code Detail

MEDICARE: STEPHANIE KING BOUDREAUX M.ED., LPC, PMH-C

MEDICARE: STEPHANIE KING BOUDREAUX M.ED., LPC, PMH-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor5445LA

General Provider Information

NPI Number : 1548834047
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE KING BOUDREAUX M.ED., LPC, PMH-C
Provider Business Mailing Address
First Line : 1663 KEED AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-8138
Country : US
Telephone Number : 225-978-5713
Fax Number :
Provider Business Practice Location Address
First Line : 1663 KEED AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-8138
Country : US
Telephone Number : 225-978-5713
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2021
Last Update Date : 05/18/2021

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Directions to “ STEPHANIE KING BOUDREAUX M.ED., LPC, PMH-C” Practice Location

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