Provider Demographics
NPI:1215257910
Name:BOUDREAU COUNSELING SERVICES
Entity type:Organization
Organization Name:BOUDREAU COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:614-477-4390
Mailing Address - Street 1:10330 SAWMILL PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7790
Mailing Address - Country:US
Mailing Address - Phone:614-477-4390
Mailing Address - Fax:614-923-9201
Practice Address - Street 1:10330 SAWMILL PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7790
Practice Address - Country:US
Practice Address - Phone:614-477-4390
Practice Address - Fax:614-923-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0701103101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty