Provider Demographics
NPI:1578162434
Name:BOSTON, LAQUESHA (LPC)
Entity Type:Individual
Prefix:
First Name:LAQUESHA
Middle Name:
Last Name:BOSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14463 GRAVELLE LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2209
Mailing Address - Country:US
Mailing Address - Phone:314-518-8004
Mailing Address - Fax:
Practice Address - Street 1:14463 GRAVELLE LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2209
Practice Address - Country:US
Practice Address - Phone:314-518-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional