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General NPI Number Information
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NPI Number | 1831595818
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Entity Type | Individual
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Provider Name | JESSICA F BOULANGER MED, LPC, NCC, CCTP
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Gender | Female
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 4414 CENTERVIEW STE 204
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City | SAN ANTONIO
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State | TX
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Zip | 78228-1432
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Country | US
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Telephone | 210-739-4200
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Fax | 210-757-3220
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Provider Business Mailing Address
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Address Line | 4414 CENTERVIEW STE 204
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City | SAN ANTONIO
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State | TX
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Zip | 78228-1432
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Country | US
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Telephone | 210-739-4200
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Fax | 210-757-3220
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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 | 67194
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 67194
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License Number State | TX
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