Individual
MR. JERRY PAUL BOUDREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L C S W
Contact information
Practice address
549 E PASS RD, SUITE P, GULFPORT, MS 39507-3261
(228) 896-9251
(228) 897-6003
Mailing address
549 E PASS RD, SUITE P, GULFPORT, MS 39507-3261
(228) 896-9251
(228) 897-6003
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0058
MS
Other
Enumeration date
11/15/2006
Last updated
07/08/2007
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