Provider Demographics
NPI:1639958606
Name:BOUDREAUX, NAIMA MELISA (LPC-A)
Entity Type:Individual
Prefix:
First Name:NAIMA
Middle Name:MELISA
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 E DORSET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1527
Mailing Address - Country:US
Mailing Address - Phone:267-240-6244
Mailing Address - Fax:
Practice Address - Street 1:13359 N HIGHWAY 183 STE 406-685
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-7153
Practice Address - Country:US
Practice Address - Phone:720-642-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional