Provider Demographics
NPI:1003597626
Name:BOESEN, VICTORIA MICHEL (MA, BCABA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MICHEL
Last Name:BOESEN
Suffix:
Gender:F
Credentials:MA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14507 ESSEN TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-7164
Mailing Address - Country:US
Mailing Address - Phone:985-233-1074
Mailing Address - Fax:
Practice Address - Street 1:17520 OLD JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3903
Practice Address - Country:US
Practice Address - Phone:225-300-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0-23-14540106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst