Basic Information
| Provider Information | |||||||||
| NPI: | 1437677895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOULIGNY | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | LEAH | ||||||||
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| Credential: | MHS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2102 GARY ST. | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187944053 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2525 YOUREE DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186750804 | ||||||||
| FaxNumber: | 3184259030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2017 | ||||||||
| LastUpdateDate: | 07/27/2018 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | LA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.