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General NPI Number Information
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NPI Number | 1487435442
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Entity Type | Individual
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Provider Name | RYAN EARL BOUDREAUX
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Gender | Male
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 2829 4TH AVE STE 215
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City | LAKE CHARLES
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State | LA
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Zip | 70601-7887
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Country | US
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Telephone | 337-707-3872
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Fax |
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Provider Business Mailing Address
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Address Line | 500 BROAD ST # 213
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City | LAKE CHARLES
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State | LA
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Zip | 70601-4335
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Country | US
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Telephone | 337-707-3872
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PLC10351
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License Number State | LA
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