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NPI Code Detail

MEDICARE: MARK LYNN BOUCHER LMFT

MEDICARE: MARK LYNN BOUCHER LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC20703CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1106H00000XOTHERCALMFT

General Provider Information

NPI Number : 1538283569
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK LYNN BOUCHER LMFT
Provider Business Mailing Address
First Line : 1208 9TH ST
Second Line :
City : MODESTO
State : CA
Zip : 95354-0713
Country : US
Telephone Number : 209-558-4464
Fax Number : 209-558-4450
Provider Business Practice Location Address
First Line : 1208 9TH ST
Second Line :
City : MODESTO
State : CA
Zip : 95354-0713
Country : US
Telephone Number : 209-558-4464
Fax Number : 209-558-4450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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Directions to “ MARK LYNN BOUCHER LMFT” Practice Location

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