Healthcare Provider Details

I. General information

NPI: 1548520273
Provider Name (Legal Business Name): MARIA BOUHARB LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 CHERRY AVE
ROYAL OAK MI
48073-3945
US

IV. Provider business mailing address

717 CHERRY AVE
ROYAL OAK MI
48073-3945
US

V. Phone/Fax

Practice location:
  • Phone: 210-379-1101
  • Fax:
Mailing address:
  • Phone: 210-379-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013620
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number66973
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401013620
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH61477470
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: