Provider Demographics
NPI:1841995024
Name:BOELTER, EMMA ROSE (MS, PLPC, NCC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:ROSE
Last Name:BOELTER
Suffix:
Gender:F
Credentials:MS, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-4131
Mailing Address - Country:US
Mailing Address - Phone:678-548-0691
Mailing Address - Fax:
Practice Address - Street 1:1539 METAIRIE RD STE A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3900
Practice Address - Country:US
Practice Address - Phone:504-517-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC9162101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty