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General NPI Number Information
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NPI Number | 1639280415
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Entity Type | Individual
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Provider Name | MALINDA CHARISSE BOUDREAUX LPC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8885 TAYLOR CIR
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City | ORANGE
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State | TX
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Zip | 77630-8822
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Country | US
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Telephone | 409-720-7292
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Fax | 409-735-3632
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Provider Business Mailing Address
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Address Line | 8885 TAYLOR CIR
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City | ORANGE
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State | TX
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Zip | 77630-8822
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Country | US
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Telephone | 409-720-7292
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Fax | 409-735-3632
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 16733
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License Number State | TX
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