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MR. JOHN DALTON BOUDREAUX MA
NPI 1417669763
Counselor - Professional in Lake Charles, LA

Active since December 19, 2022PECOS Enrolled
4105 KIRKMAN ST, LAKE CHARLES, LA 70607(337) 475-3105(337) 475-3105 Get Directions Write a Review

NPPES record last updated: November 10, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 10, 2025, Jan 4, 2023, Dec 19, 2022 (3 updates tracked since 2022).

About Mr. John Dalton Boudreaux Ma NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JOHN DALTON BOUDREAUX MA (NPI 1417669763) is an individual professional provider in Lake Charles, Louisiana, licensed in Louisiana (8871) and active in the NPI registry since December 2022. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1417669763
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameMR. JOHN DALTON BOUDREAUXCredential: MA
Location Address4105 KIRKMAN STLake Charles, LA 70607-4603
Mailing Address4105 Kirkman StLake Charles, LA 70607-4603 · (337) 475-3100 · Fax (337) 475-3105
Phone(337) 475-3105
Fax(337) 475-3105
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateDecember 19, 2022
Last NPPES UpdateNovember 10, 20253 updates tracked since enumeration
NPPES CertifiedNovember 10, 2025
✔ NPI 1417669763 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in LA · 8871
4105 KIRKMAN ST, Lake Charles, LA 70607
Open in Google Maps ↗

Secondary Practice Locations 2

Location 12651 E Napoleon StSulphur, LA 70663-3707 · Phone (337) 625-6750
Location 21925 Enterprise BlvdLake Charles, LA 70601-6371 · Phone (337) 429-5129 · Fax (337) 214-2077

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. John Dalton Boudreaux Ma is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID345754107
PECOS Enrollment IDI20250704000383
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DEANNA TURNER CAC
Counselor (Addiction (Substance Use Disorder))
4105 KIRKMAN ST
LAKE CHARLES, LA 70607
Calcasieu Parish (337) 475-8022
TANYA JANUARY RN
Registered Nurse
4105 KIRKMAN ST
LAKE CHARLES, LA 70607
Calcasieu Parish (337) 475-8022
C. ELISKA WAGNON
Counselor (Mental Health)
4105 KIRKMAN ST
LAKE CHARLES, LA 70607
Calcasieu Parish (337) 475-8022
MRS. AMY ROSE FELICE RAC
Counselor (Addiction (Substance Use Disorder))
4105 KIRKMAN ST
LAKE CHARLES, LA 70607
Calcasieu Parish (337) 475-8022
CAROLYN ANN DAVIS LPC, NCC, CCDP-D
Counselor (Professional)
4105 KIRKMAN ST
LAKE CHARLES, LA 70607
Calcasieu Parish (337) 475-8022
DIANE GAIL FRUGE RAC
Counselor (Addiction (Substance Use Disorder))
4105 KIRKMAN ST
LAKE CHARLES, LA 70607
Calcasieu Parish (337) 475-2088
MR. JEROME HOLLAND G.S.W.
Social Worker (Clinical)
4105 KIRKMAN ST
LAKE CHARLES, LA 70607
Calcasieu Parish (337) 475-8022
MR. MARK SHANE ANDERSON RAC, CCDP, CCGC
Counselor (Addiction (Substance Use Disorder))
4105 KIRKMAN ST
LAKE CHARLES, LA 70607
Calcasieu Parish (337) 475-8738

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is John Boudreaux's NPI number?

The NPI number for John Boudreaux is 1417669763. It was assigned to this individual provider in the NPPES registry on December 19, 2022.

Where is John Boudreaux located?

John Boudreaux practices at 4105 Kirkman St, Lake Charles, LA 70607. The listed phone number is (337) 475-3105.

What is John Boudreaux's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is John Boudreaux enrolled in Medicare?

Yes. John Boudreaux is registered in the Medicare PECOS enrollment system.

What insurance does John Boudreaux accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health, Ambetter from Superior HealthPlan and Blue Cross and Blue Shield of Louisiana and 1 other insurer list John Boudreaux as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for John Boudreaux was last updated on November 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.