Healthcare Provider Details

I. General information

NPI: 1770864910
Provider Name (Legal Business Name): ARI BOUSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CHURCH ST
LEWISTON ME
04240-3607
US

IV. Provider business mailing address

4 CHURCH ST
LEWISTON ME
04240-3607
US

V. Phone/Fax

Practice location:
  • Phone: 207-831-9415
  • Fax:
Mailing address:
  • Phone: 207-831-9415
  • Fax: 207-831-9415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC6835
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: