Provider Demographics
NPI:1154580579
Name:BOUDREAUX MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:BOUDREAUX MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PMHNP
Authorized Official - Phone:601-616-1439
Mailing Address - Street 1:98 BURNHAM RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2759
Mailing Address - Country:US
Mailing Address - Phone:601-664-0204
Mailing Address - Fax:
Practice Address - Street 1:98 BURNHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2759
Practice Address - Country:US
Practice Address - Phone:601-664-0204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850842261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health