Provider Demographics
NPI:1023381167
Name:BOUDREAUX, LISA A (CPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W PINHOOK RD
Mailing Address - Street 2:BLDG. 3, STE. 226
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2448
Mailing Address - Country:US
Mailing Address - Phone:337-534-4789
Mailing Address - Fax:337-534-4789
Practice Address - Street 1:1001 W PINHOOK RD
Practice Address - Street 2:BLDG. 3, STE. 226
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2448
Practice Address - Country:US
Practice Address - Phone:337-534-4789
Practice Address - Fax:337-534-4789
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional