Provider Demographics
NPI:1144618190
Name:BOUSTANY, ERIK NOLAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:NOLAN
Last Name:BOUSTANY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 DELMAR LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3114
Mailing Address - Country:US
Mailing Address - Phone:337-739-5745
Mailing Address - Fax:
Practice Address - Street 1:112 DELMAR LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3114
Practice Address - Country:US
Practice Address - Phone:337-739-5745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional