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General NPI Number Information
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NPI Number | 1336604537
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Entity Type | Individual
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Provider Name | DANIELLE BOUDREAUX-HAGGERTY MA, LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 37748 SKY HIGH DR
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City | MURRIETA
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State | CA
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Zip | 92562-3099
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Country | US
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Telephone | 951-966-5042
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Fax |
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Provider Business Mailing Address
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Address Line | 29410 HUNCO WAY
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-2704
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT110790
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License Number State | CA
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