Organization
BOSLEY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARKUS REVIELLE BOSLEY PSS, PAS-DOT, LAC (ADMINISTRATOR)
(318) 791-9805
Entity
Organization
Contact information
Practice address
1108 STUBBS AVE, MONROE, LA 71201-5620
(318) 791-9805
Mailing address
1108 STUBBS AVE, MONROE, LA 71201-5620
(318) 791-9805
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/04/2024
Last updated
01/14/2025
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