Elizabeth Boudreaux

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MC60773855 Issued in WA

Practice address

21300 68TH Ave W Ste 105
Lynnwood, WA 98036-7310

Phone

(425) 412-3155

Fax

(425) 249-3522

NPI assigned

Nov 5, 2018

Last updated

Jul 3, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 24, 2025 through Nov 24, 2027

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Squareone Services, SPC

  dba Square One

  • Community/Behavioral Health Agency
  • Lynnwood, WA
  • NPI 1730654849
  NPD (past)

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

{
    "created_epoch": "1541376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562112000000",
    "number": "1689142960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21300 68TH AVE W STE 105",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980367310",
            "telephone_number": "425-412-3155",
            "fax_number": "425-249-3522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21300 68TH AVE W STE 105",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980367310",
            "telephone_number": "425-412-3155",
            "fax_number": "425-249-3522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAUX",
        "first_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-05",
        "last_updated": "2019-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO60702738",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC60773855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roz R. Bornstein, LICSW, MSW
• Julie Ann Borovik, MA, LMFT
• Ingrid Borrero
• Iman Warsame Bot, PROVIDER RN
• Gini Bouche
• James Boulding-Bridges, LPC, CST
• Boulom Chiropractic PS Inc (Essential Chirowellness)
• Jeudi Taing Boulom, DC
• Sky Boulom, DC
• Leslie Catherine Olivia Bourgoin, LMHC

• Mental Health Counselor in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.