Teri Boudreau, LTD.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180003442 Issued in IL

Legal business name

TERI BOUDREAU, LTD.

Practice address

310 N Convent St
Bourbonnais, IL 60914-2099

Phone

(815) 929-1940

NPI assigned

Sep 20, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Teri Dean Boudreau, LCPC

Title

Licensed Clinical Professional Coun

Phone

(815) 929-1940

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260403200000",
    "number": "1346436672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 334",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "609150334",
            "telephone_number": "815-929-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 N CONVENT ST",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142099",
            "telephone_number": "815-929-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TERI BOUDREAU, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-20",
        "last_updated": "2009-12-10",
        "status": "A",
        "authorized_official_last_name": "BOUDREAU",
        "authorized_official_first_name": "TERI",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "LICENSED CLINICAL PROFESSIONAL COUN",
        "authorized_official_telephone_number": "815-929-1940",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180003442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2009; 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.