Provider Demographics
NPI:1639280415
Name:BOUDREAUX, MALINDA CHARISSE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:CHARISSE
Last Name:BOUDREAUX
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 1:8885 TAYLOR CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-8822
Mailing Address - Country:US
Mailing Address - Phone:409-720-7292
Mailing Address - Fax:409-735-3632
Practice Address - Street 1:8885 TAYLOR CIR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-8822
Practice Address - Country:US
Practice Address - Phone:409-720-7292
Practice Address - Fax:409-735-3632
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health