Provider Demographics
NPI:1851540934
Name:BOUDREAUX, ELIZABETH LYNN-MARIE (MHPP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LYNN-MARIE
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:MS
Other - First Name:BETSY
Other - Middle Name:LYNN-MARIE
Other - Last Name:BOUDREAUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHPP
Mailing Address - Street 1:5537 BLEAUX AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0737
Mailing Address - Country:US
Mailing Address - Phone:479-872-5580
Mailing Address - Fax:479-872-5581
Practice Address - Street 1:1316 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-4557
Practice Address - Country:US
Practice Address - Phone:479-471-6892
Practice Address - Fax:479-471-6859
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health