Basic Information
| Provider Information | |||||||||
| NPI: | 1346890191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOUDREAUX | ||||||||
| FirstName: | SHARIE | ||||||||
| MiddleName: | RENELL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 BAMBI LANE | ||||||||
| Address2: | LOT 1 | ||||||||
| City: | PORT BARRE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374180782 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210600 OXNARD ST | ||||||||
| Address2: | SUITE 1800 | ||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372054444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2019 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.