Provider Demographics
NPI:1568805364
Name:INTEGRATED BEHAVIORAL HEALTH & WELLNESS CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:INTEGRATED BEHAVIORAL HEALTH & WELLNESS CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-232-0034
Mailing Address - Street 1:3 HERMANN MUSEUM CIRCLE DR APT 5108
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7970
Mailing Address - Country:US
Mailing Address - Phone:713-232-0034
Mailing Address - Fax:
Practice Address - Street 1:2646 S LOOP W
Practice Address - Street 2:180 D
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35073103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3259929Medicaid
TX3259929Medicaid