Provider Demographics
NPI:1568253011
Name:BOUDREAUX, SAVANNA HOPE
Entity type:Individual
Prefix:
First Name:SAVANNA
Middle Name:HOPE
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 N HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-3070
Mailing Address - Country:US
Mailing Address - Phone:918-282-7201
Mailing Address - Fax:833-965-2766
Practice Address - Street 1:2310 N HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-3070
Practice Address - Country:US
Practice Address - Phone:918-282-7201
Practice Address - Fax:833-965-2766
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician