Provider Demographics
NPI:1679314520
Name:BOSLEY, MARKUS (PSS, PAS-DOT, LAC)
Entity type:Individual
Prefix:
First Name:MARKUS
Middle Name:
Last Name:BOSLEY
Suffix:
Gender:M
Credentials:PSS, PAS-DOT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 STUBBS AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5620
Mailing Address - Country:US
Mailing Address - Phone:318-791-9805
Mailing Address - Fax:318-855-4396
Practice Address - Street 1:500 N 21ST ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6532
Practice Address - Country:US
Practice Address - Phone:318-791-9805
Practice Address - Fax:318-855-4396
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALAC-5143101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)