Provider Demographics
NPI:1346890191
Name:BOUDREAUX, SHARIE RENELL
Entity type:Individual
Prefix:
First Name:SHARIE
Middle Name:RENELL
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 BAMBI LANE
Mailing Address - Street 2:LOT 1
Mailing Address - City:PORT BARRE
Mailing Address - State:LA
Mailing Address - Zip Code:70577
Mailing Address - Country:US
Mailing Address - Phone:337-418-0782
Mailing Address - Fax:
Practice Address - Street 1:210600 OXNARD ST
Practice Address - Street 2:SUITE 1800
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367
Practice Address - Country:US
Practice Address - Phone:337-205-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst