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General NPI Number Information
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NPI Number | 1598129553
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Entity Type | Individual
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Provider Name | KELLI ANNE BOUSCHER LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 7658 N SANTA FE AVE
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City | FRESNO
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State | CA
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Zip | 93722-2391
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Country | US
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Telephone | 559-346-9003
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Fax |
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Provider Business Mailing Address
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Address Line | 1677 W SHAW AVE STE 107
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City | FRESNO
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State | CA
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Zip | 93711-3515
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Country | US
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Telephone | 559-270-4744
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 150994
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License Number State | CA
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