Provider Demographics
NPI:1912236084
Name:BOUDLOCHE, LLOYD JOSEPH JR (EDD - LPC)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:JOSEPH
Last Name:BOUDLOCHE
Suffix:JR
Gender:M
Credentials:EDD - LPC
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 1148
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-1148
Mailing Address - Country:US
Mailing Address - Phone:318-376-4425
Mailing Address - Fax:
Practice Address - Street 1:3201 ARMAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3915
Practice Address - Country:US
Practice Address - Phone:318-600-6640
Practice Address - Fax:318-605-2662
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4601101YP2500X
LAL-005103K00000X
LA1-12-120168103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2349376Medicaid