Individual
JUSTIN KYLE BOUDREAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
530 E 34TH ST, JOPLIN, MO 64804-3926
(417) 347-7600
Mailing address
PO BOX 2526, JOPLIN, MO 64803-2526
(417) 347-7600
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2017036049
MO
Other
Enumeration date
12/26/2017
Last updated
12/26/2017
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