Provider Demographics
NPI:1750907242
Name:GOUDREAU, SHARA (LMHC)
Entity type:Individual
Prefix:DR
First Name:SHARA
Middle Name:
Last Name:GOUDREAU
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10760 EMILIA ISLES TER
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4965
Mailing Address - Country:US
Mailing Address - Phone:917-528-1137
Mailing Address - Fax:
Practice Address - Street 1:10760 EMILIA ISLES TER
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-4965
Practice Address - Country:US
Practice Address - Phone:917-528-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health