Provider Demographics
NPI:1508103102
Name:BOUDREAUX, SHARON DUGAS (BCBA)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DUGAS
Last Name:BOUDREAUX
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-8936
Mailing Address - Country:US
Mailing Address - Phone:706-254-1688
Mailing Address - Fax:
Practice Address - Street 1:424 E PRESIDENT AVE
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5500
Practice Address - Country:US
Practice Address - Phone:662-205-4375
Practice Address - Fax:662-584-2990
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1-12-12034103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst