Provider Demographics
NPI:1922286780
Name:BOUD, MARY MARGARET (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:BOUD
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 1:3235 SPARKS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6151
Mailing Address - Country:US
Mailing Address - Phone:307-638-8975
Mailing Address - Fax:307-634-9267
Practice Address - Street 1:3235 SPARKS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-6151
Practice Address - Country:US
Practice Address - Phone:307-638-8975
Practice Address - Fax:307-634-9267
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-618101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional