Provider Demographics
NPI:1386141703
Name:BOUDREAUX, ANCA MARIA (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:ANCA
Middle Name:MARIA
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 SE 1ST PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-5228
Mailing Address - Country:US
Mailing Address - Phone:408-470-9406
Mailing Address - Fax:
Practice Address - Street 1:7100 FORT DENT WAY STE 220
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-8553
Practice Address - Country:US
Practice Address - Phone:206-708-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60578269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty