Provider Demographics
NPI:1144922303
Name:BOUDREAUX, EMILY ROSE (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BERKLEY MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-8111
Mailing Address - Country:US
Mailing Address - Phone:337-331-4638
Mailing Address - Fax:
Practice Address - Street 1:70 W BEAVER ST
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-1582
Practice Address - Country:US
Practice Address - Phone:724-900-4130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC15456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional