Provider Demographics
NPI:1700037488
Name:BOUDREAUX, SUSAN L (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14528 LATROBE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2608
Mailing Address - Country:US
Mailing Address - Phone:719-229-3818
Mailing Address - Fax:
Practice Address - Street 1:14528 LATROBE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2608
Practice Address - Country:US
Practice Address - Phone:719-229-3818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist