Su Yong Boudreau

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT128747 Issued in CA

Practice address

1140 Wall St # 355
La Jolla, CA 92037-4531

Phone

(858) 218-0863

NPI assigned

Apr 8, 2015

Sex

Female

Sole proprietor

No

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)

Not enrolled

State licenses

Practice roles

Locations

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.

• Conscious Marriage and Family Therapy, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sacramento, CA
  • NPI 1326785361
  NPD Authorized official
• Liveconscious Therapy, Inc

  • Marriage & Family Therapist
  • Sacramento, CA
  • NPI 1881486850
  NPD Authorized official

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

{
    "created_epoch": "1428451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1336535210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 WALL ST # 355",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920374531",
            "telephone_number": "858-218-0863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 WALL ST # 355",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920374531",
            "telephone_number": "858-218-0863"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "892 27th St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "92154",
            "country_code": "US",
            "telephone_number": "619-575-4687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "SU",
        "middle_name": "YONG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-08",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT128747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abha M Bosworth, PA
• Deborah Bothun
• Gregory P Botta, M.D./PH.D.
• Lauren Marie Botta, NP
• Michael J. Botte, M.D.
• Boughton Dermatology
• R Scott Boughton, M.D.
• Diane Mary Bousquin, L.AC
• Kerri N. Boutelle, PHD
• Ana Michelle Bowens, LCSW

• Marriage & Family Therapist in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; 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.