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General NPI Number Information
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NPI Number | 1366055865
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Entity Type | Organization
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Legal Business Name | MARYELIZABETH LEBOEUF PHD, LLC
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 05/25/2024
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Provider Practice Location Address
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Address Line | 1651 THIBODEAUX AVE STE A
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City | BATON ROUGE
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State | LA
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Zip | 70806-8271
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Country | US
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Telephone | 225-267-7763
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Fax | 855-398-6697
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Provider Business Mailing Address
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Address Line | 1651 THIBODEAUX AVE STE A
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City | BATON ROUGE
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State | LA
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Zip | 70806-8271
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Country | US
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Telephone | 225-267-7763
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Fax | 855-398-6697
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARYELIZABETH FORMAN LEBOEUF
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Credential | PHD
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Telephone | 225-267-7763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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