Healthcare Provider Details

I. General information

NPI: 1639633902
Provider Name (Legal Business Name): MS. SARAH N. BOULERICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 SPRUCE ST
GRIDLEY CA
95948-2128
US

IV. Provider business mailing address

1085 E 8TH ST
CHICO CA
95928-5907
US

V. Phone/Fax

Practice location:
  • Phone: 530-846-7305
  • Fax:
Mailing address:
  • Phone: 831-444-5337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: