Provider Demographics
NPI:1750421608
Name:BOZE, MICHELLE M (PSYD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:BOZE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-1536
Mailing Address - Country:US
Mailing Address - Phone:985-635-6943
Mailing Address - Fax:985-231-6733
Practice Address - Street 1:2140 8TH ST STE C
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1924
Practice Address - Country:US
Practice Address - Phone:985-327-0400
Practice Address - Fax:985-231-6733
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA891103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA891OtherLICENSE