Healthcare Provider Details

I. General information

NPI: 1962952903
Provider Name (Legal Business Name): CAMRY BOUDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 DACOMA ST
HOUSTON TX
77092-8611
US

IV. Provider business mailing address

111 OAK ST
MCCOMB MS
39648-3736
US

V. Phone/Fax

Practice location:
  • Phone: 713-686-9194
  • Fax: 713-686-9413
Mailing address:
  • Phone: 985-707-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number86103
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: