1831595818 NPI number — JESSICA F BOULANGER MED, LPC, NCC, CCTP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831595818 NPI number — JESSICA F BOULANGER MED, LPC, NCC, CCTP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOULANGER
Provider First Name:
JESSICA
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MED, LPC, NCC, CCTP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831595818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4414 CENTERVIEW STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78228-1432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-739-4200
Provider Business Mailing Address Fax Number:
210-757-3220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4414 CENTERVIEW STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78228-1432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-739-4200
Provider Business Practice Location Address Fax Number:
210-757-3220
Provider Enumeration Date:
11/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  67194 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 67194 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 226826 . This is a "NATIONAL CERTIFIED COUNSELOR (NCC) - NATIONAL BOARD OF CERTIFIED COUNSELORS NBCC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 526802 . This is a "AVAILITY -NATIONAL PROVIDER WORKFLOW SOLUTIONS FOR PAYORS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 998642 . This is a "CERTIFIED CLINICAL TRAUMA PROFESSIONAL (CCTP) - EVERGREEN CERTIFICATIONS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 67194 . This is a "LICENSED PROFESSIONAL COUNSELOR (LPC) - BEHAVIORAL HEALTH EXECUTIVE COUNSEL BHEC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 12788486 . This is a "CAQH NATIONAL PROVIDER DATABASE" identifier . This identifiers is of the category "OTHER".




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