Provider Demographics
NPI:1285453746
Name:BOUDION, JAMAL TRAVIS (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:TRAVIS
Last Name:BOUDION
Suffix:
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 BEECHGROVE BLVD APT E
Mailing Address - Street 2:
Mailing Address - City:WESTWEGO
Mailing Address - State:LA
Mailing Address - Zip Code:70094-3807
Mailing Address - Country:US
Mailing Address - Phone:504-287-9000
Mailing Address - Fax:
Practice Address - Street 1:501 MANHATTAN BLVD
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-4443
Practice Address - Country:US
Practice Address - Phone:504-250-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health