Provider Demographics
NPI:1639544034
Name:BOUDREAU, DANIELLE MARIE (LMFT 121813)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:BOUDREAU
Suffix:
Gender:F
Credentials:LMFT 121813
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8575 ELK GROVE FLORIN RD
Mailing Address - Street 2:APT. 212
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-9532
Mailing Address - Country:US
Mailing Address - Phone:916-236-9293
Mailing Address - Fax:
Practice Address - Street 1:7919 FOLSOM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2626
Practice Address - Country:US
Practice Address - Phone:916-877-7851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA121813106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist