Healthcare Provider Details

I. General information

NPI: 1205759776
Provider Name (Legal Business Name): NETANYA BOOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 MADELINE ST
RAYVILLE LA
71269-2514
US

IV. Provider business mailing address

3211 STOWERS DR
MONROE LA
71201-1945
US

V. Phone/Fax

Practice location:
  • Phone: 318-732-8941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: