Provider Demographics
NPI:1568782068
Name:BOUDREAUX, DIANE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:3 HERMANN MUSEUM CIRCLE DR APT 5108
Mailing Address - Street 2:INTEGRATED BEHAVIORAL HEALTH&WELLNESS CONSULTANTS,PLLC
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7970
Mailing Address - Country:US
Mailing Address - Phone:281-997-7001
Mailing Address - Fax:888-870-6542
Practice Address - Street 1:2646 S LOOP W
Practice Address - Street 2:SUITE 180D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2665
Practice Address - Country:US
Practice Address - Phone:281-997-7001
Practice Address - Fax:888-870-6542
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2015-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX35073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3259929Medicaid
TX3259929Medicaid