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General NPI Number Information
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NPI Number | 1548358583
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Entity Type | Individual
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Provider Name | MRS. BONNIE BOUCHER
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10801 LOMAS BLVD NE STE 105
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-5474
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Country | US
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Telephone | 505-620-9785
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11068
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City | ALBUQUERQUE
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State | NM
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Zip | 87192-0068
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Country | US
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Telephone | 505-620-9785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0065142
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License Number State | NM
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