Provider Demographics
NPI:1134848682
Name:TREE HOUSE ENRICHMENTS MASSAGE THERAPY SERVICES,LLC
Entity type:Organization
Organization Name:TREE HOUSE ENRICHMENTS MASSAGE THERAPY SERVICES,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHANICE
Authorized Official - Middle Name:UNCHELLE
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:225-428-6614
Mailing Address - Street 1:4303 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-4134
Mailing Address - Country:US
Mailing Address - Phone:281-219-5429
Mailing Address - Fax:225-256-0490
Practice Address - Street 1:4303 PLANK RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-4134
Practice Address - Country:US
Practice Address - Phone:281-219-5429
Practice Address - Fax:225-256-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760019913OtherVETERANS DEPT
LA176001913Medicaid