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General NPI Number Information
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NPI Number | 1851020390
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Entity Type | Individual
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Provider Name | ANNETTE BOUW LAC
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Gender | Female
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 11518 E APACHE TRL STE 129
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City | APACHE JUNCTION
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State | AZ
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Zip | 85120-3572
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Country | US
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Telephone | 480-784-1514
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 N CAMBRIDGE CIR
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City | CHANDLER
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State | AZ
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Zip | 85225-1601
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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