Healthcare Provider Details

I. General information

NPI: 1831818319
Provider Name (Legal Business Name): TERRI L BOUDREAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 10/19/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 W MORRIS AVE STE E
HAMMOND LA
70403-3854
US

IV. Provider business mailing address

1417 W MORRIS AVE STE E
HAMMOND LA
70403-3854
US

V. Phone/Fax

Practice location:
  • Phone: 985-662-3799
  • Fax: 985-662-3829
Mailing address:
  • Phone: 985-662-3799
  • Fax: 985-662-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: