Healthcare Provider Details

I. General information

NPI: 1609290170
Provider Name (Legal Business Name): BRENDA BOUDREAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 EAST ST STE 113
REDDING CA
96001-0855
US

IV. Provider business mailing address

1635 BARBARA RD
REDDING CA
96003-3121
US

V. Phone/Fax

Practice location:
  • Phone: 530-605-1361
  • Fax: 530-605-1363
Mailing address:
  • Phone: 530-415-9281
  • Fax: 530-605-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT78537
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberLMFT 78537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: