Active NPI
Teri Boudreau, LCPC
- Counselor
- Bourbonnais, IL
National Provider Identifier
1295746675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 21 Heritage Dr
Ste 102
Bourbonnais, IL 60914 - Phone
- (815) 937-8204
- Fax
- (815) 937-8798
- NPI assigned
- Aug 10, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | IL | Primary |
Addresses
Primary practice location
21 Heritage Dr
Ste 102
Bourbonnais, IL 60914
Mailing address
9223 W St Francis Rd
Frankfort, IL 60423
Phone (815) 806-3111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260330003178 | IL | Order and Referring Only - Mental Health Counselor | 4587149372 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180003442 | IL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295746675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9223 W ST FRANCIS RD",
"city": "FRANKFORT",
"state": "IL",
"postal_code": "60423",
"telephone_number": "815-806-3111",
"fax_number": "815-464-2621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 HERITAGE DR",
"address_2": "STE 102",
"city": "BOURBONNAIS",
"state": "IL",
"postal_code": "60914",
"telephone_number": "815-937-8204",
"fax_number": "815-937-8798"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDREAU",
"first_name": "TERI",
"name_prefix": "Mrs.",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bourbonnais, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.