Provider Demographics
NPI:1366055865
Name:MARYELIZABETH LEBOEUF PHD, LLC
Entity type:Organization
Organization Name:MARYELIZABETH LEBOEUF PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYELIZABETH
Authorized Official - Middle Name:FORMAN
Authorized Official - Last Name:LEBOEUF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:225-267-7763
Mailing Address - Street 1:1651 THIBODEAUX AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8271
Mailing Address - Country:US
Mailing Address - Phone:225-267-7763
Mailing Address - Fax:855-398-6697
Practice Address - Street 1:1651 THIBODEAUX AVE STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8271
Practice Address - Country:US
Practice Address - Phone:225-267-7763
Practice Address - Fax:855-398-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty