Healthcare Provider Details

I. General information

NPI: 1215888656
Provider Name (Legal Business Name): EMILY LYNN BOUCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 PORT ROYAL RD STE 301
SPRING HILL TN
37174-3512
US

IV. Provider business mailing address

2657A THOMPSON STATION RD E
THOMPSONS STATION TN
37179-9281
US

V. Phone/Fax

Practice location:
  • Phone: 615-439-6180
  • Fax:
Mailing address:
  • Phone: 615-418-7892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9517
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: