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General NPI Number Information
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NPI Number | 1679314520
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Entity Type | Individual
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Provider Name | MARKUS BOSLEY PSS, PAS-DOT, LAC
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Gender | Male
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 500 N 21ST ST
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City | MONROE
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State | LA
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Zip | 71201-6532
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Country | US
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Telephone | 318-791-9805
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Fax | 318-855-4396
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Provider Business Mailing Address
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Address Line | 1108 STUBBS AVE
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City | MONROE
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State | LA
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Zip | 71201-5620
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Country | US
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Telephone | 318-791-9805
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Fax | 318-855-4396
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LAC-5143
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License Number State | LA
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