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General NPI Number Information
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NPI Number | 1689809972
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Entity Type | Individual
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Provider Name | MARIJ BOUWMANS MFT
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Gender | Female
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Dates
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Enumeration Date | 05/15/2009
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 2014 TULARE ST 610
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City | FRESNO
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State | CA
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Zip | 93721-2014
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Country | US
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Telephone | 559-226-4855
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Fax |
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Provider Business Mailing Address
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Address Line | 844 N VAN NESS AVE
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City | FRESNO
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State | CA
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Zip | 93728-3426
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Country | US
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Telephone | 559-441-0201
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Fax | 559-442-3164
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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 | MFT34136
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License Number State | CA
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