MEDICARE: JESSICA F BOULANGER MED, LPC, NCC, CCTP

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
1	101YM0800X	Mental Health Counselor	67194	TX
2	101YP2500X	Professional Counselor	67194	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	226826	OTHER		NATIONAL CERTIFIED COUNSELOR (NCC) - NATIONAL BOARD OF CERTIFIED COUNSELORS NBCC
2	526802	OTHER	TX	AVAILITY -NATIONAL PROVIDER WORKFLOW SOLUTIONS FOR PAYORS
3	998642	OTHER	TX	CERTIFIED CLINICAL TRAUMA PROFESSIONAL (CCTP) - EVERGREEN CERTIFICATIONS
4	67194	OTHER	TX	LICENSED PROFESSIONAL COUNSELOR (LPC) - BEHAVIORAL HEALTH EXECUTIVE COUNSEL BHEC
5	12788486	OTHER		CAQH NATIONAL PROVIDER DATABASE

General Provider Information

NPI Number	:	1831595818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA F BOULANGER MED, LPC, NCC, CCTP

Provider Business Mailing Address
First Line	:	4414 CENTERVIEW STE 204
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1432
Country	:	US
Telephone Number	:	210-739-4200
Fax Number	:	210-757-3220

Provider Business Practice Location Address
First Line	:	4414 CENTERVIEW STE 204
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1432
Country	:	US
Telephone Number	:	210-739-4200
Fax Number	:	210-757-3220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	04/28/2025

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Directions to “ JESSICA F BOULANGER MED, LPC, NCC, CCTP” Practice Location

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