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MR. KENNY JOSEPH BOUDREAUX BA. B.S. PSYCHOLOGY

>> Case Manager/Care Coordinator >> Other Service Providers

Registrant NPI Number: 1750606646

Individual Registrant:
MR. KENNY JOSEPH BOUDREAUX BA. B.S. PSYCHOLOGY
Gender: M
Not Sole Proprietor

Location and contact information for practice:
3407 SHAMROCK CT  GAUTIER, MS 39553-6429 US
Tel: 228-497-0690  Fax: 228-497-1363

Contact information for business:
3407 SHAMROCK CT  GAUTIER, MS 39553-6429 US
Tel: 228-497-0690  Fax: 228-497-1363

Registration Information:
NPI: 1750606646
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y171M00000XOther Service Providers
Case Manager/Care Coordinator

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
00018214MS05




HEALTH CARE JOBS MS - Page 1

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