Michelle Denise Boucher-Snodgrass, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

45-732 Issued in MS

Practice address

2449 N Park Dr Ste C
Meridian, MS 39305-2669

Phone

(601) 282-5250

Fax

(601) 286-5305

NPI assigned

Aug 14, 2006

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

Other identifiers 1

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

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.

• Shine Pediatric Psychology Services PLLC

  • Adolescent and Children Mental Health Clinic/Center
  • Meridian, MS
  • NPI 1982321964
  NPD Authorized official
• Psychology Associates, LLC

  • Psychologist
  • Meridian, MS
  • NPI 1336335546
  NPD (past)

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1386657914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2449 N PARK DR STE C",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393052669",
            "telephone_number": "601-282-5250",
            "fax_number": "601-286-5305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2449 N PARK DR STE C",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393052669",
            "telephone_number": "601-282-5250",
            "fax_number": "601-286-5305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHER-SNODGRASS",
        "first_name": "MICHELLE",
        "middle_name": "DENISE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2024-07-29",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MS",
            "license": "45-732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07170249",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Baleigh N Booker, DPT
• A Gary Boone, M.D.
• Gabrielle Boone, NP-C
• Luis V Borrell, M.D.
• Morgan Alyse Boswell, D.O.
• Terri Bourrage
• Robert Bowles, RPH
• Susan Justice Bowles, RPH
• Benjamin Edgar Box, M.D.
• John Timothy Boyd, M.D.

• Psychologist in Meridian, MS
• Providers in Meridian, MS by specialty
• Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; 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.