# BOSLEY CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356182208
- **Authorized official:** MARKUS REVIELLE BOSLEY PSS, PAS-DOT, LAC (ADMINISTRATOR)
- **Authorized official phone:** (318) 791-9805

## Contact information

- **Practice address:** 1108 STUBBS AVE, MONROE, LA 71201-5620
- **Practice address phone:** (318) 791-9805
- **Mailing address:** 1108 STUBBS AVE, MONROE, LA 71201-5620
- **Mailing address phone:** (318) 791-9805

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/04/2024
- **Last updated:** 01/14/2025