Sallie Ann Boulos-Sophy, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

36441 Issued in TX

Practice address

4601 Spicewood Springs Rd
BLDG 4, Suite 200
Austin, TX 78759

Phone

(512) 467-1376

Fax

(512) 467-8658

NPI assigned

Sep 9, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Creative Solutions Behavioral Health, PLLC

  • Clinical Psychologist
  • Cedar Park, TX
  • NPI 1649824822
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1194150235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11604 SANTA ELENA LN",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787175077",
            "telephone_number": "512-757-2641",
            "fax_number": "512-467-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 SPICEWOOD SPRINGS RD",
            "address_2": "BLDG 4, SUITE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78759",
            "telephone_number": "512-467-1376",
            "fax_number": "512-467-8658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULOS-SOPHY",
        "first_name": "SALLIE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-09",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "36441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jade A Boudreaux, CRNA
• Naima Melisa Boudreaux, LPC-A
• Sara Bouffard, PA-C
• Lisa Daniele Bouillion, AGNP-C
• Imane Boulares, LPC-ASSOCIATE
• Lisa Marie Meredith Bourbeau, DO
• Patricia Dolan Bouressa, LCSW
• Blaise T Bourgeois, PT, DPT
• Larisa Bourgeois, S.L.P.
• Sebastian Bourgeois, LPC

• Psychologist in Austin, TX
• Providers in Austin, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.