Provider Demographics
NPI:1093130361
Name:HOKEY POKEY COUNSELING
Entity Type:Organization
Organization Name:HOKEY POKEY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE, FAMILY AND CHILD
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:719-229-3818
Mailing Address - Street 1:2790 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5337
Mailing Address - Country:US
Mailing Address - Phone:719-229-3818
Mailing Address - Fax:
Practice Address - Street 1:2790 N ACADEMY BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5337
Practice Address - Country:US
Practice Address - Phone:719-229-3818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty