Healthcare Provider Details

I. General information

NPI: 1639117880
Provider Name (Legal Business Name): LUC BOUDREAU PCA, LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NE STUCKI AVE STE 140
HILLSBORO OR
97124-7533
US

IV. Provider business mailing address

6154 SW 161ST PL
BEAVERTON OR
97007-4006
US

V. Phone/Fax

Practice location:
  • Phone: 877-325-8824
  • Fax:
Mailing address:
  • Phone: 323-828-0618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR11000
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61660610
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: