MEDICARE: DR. STACEY BOUFFARD PH.D.

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
1	103TC0700X	Clinical Psychologist	PSY-005788	AZ

General Provider Information

NPI Number	:	1972323178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY BOUFFARD PH.D.

Provider Business Mailing Address
First Line	:	412 E 4TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-7804
Country	:	US
Telephone Number	:	520-360-2270
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 E 4TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-7804
Country	:	US
Telephone Number	:	520-360-2270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2024
Last Update Date	:	10/12/2024

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Directions to “ DR. STACEY BOUFFARD PH.D.” Practice Location

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