Provider Demographics
NPI:1508103102
Name:BOUDREAUX, SHARON DUGAS (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DUGAS
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-8936
Mailing Address - Country:US
Mailing Address - Phone:706-254-1688
Mailing Address - Fax:
Practice Address - Street 1:146 S THOMAS ST
Practice Address - Street 2:STE. E
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5328
Practice Address - Country:US
Practice Address - Phone:662-840-0974
Practice Address - Fax:662-840-0388
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1-12-12034103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst