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General NPI Number Information
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NPI Number | 1205793122
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Entity Type | Individual
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Provider Name | COREY ANTHONY BOUDREAUX
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Gender | Male
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 4202 N I-10 SERVICE RD
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City | W METAIRIE
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State | LA
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Zip | 70006
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Country | US
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Telephone | 888-880-9270
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Fax |
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Provider Business Mailing Address
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Address Line | 2440 BEHRMAN HWY
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City | NEW ORLEANS
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State | LA
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Zip | 70114-7810
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Country | US
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Telephone | 504-421-8637
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | LA
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