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General NPI Number Information
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NPI Number | 1902999410
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Entity Type | Organization
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Legal Business Name | CONSTANCE BOUVIER, PH.D., CLINICAL PSYCHOLOGIST, INC.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16052 BEACH BLVD STE 228
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647
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Country | US
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Telephone | 714-841-3465
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Fax | 714-841-1882
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Provider Business Mailing Address
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Address Line | 16052 BEACH BLVD STE 228
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647
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Country | US
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Telephone | 714-841-3465
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Fax | 714-841-1882
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. CONSTANCE BOUVIER
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Credential | PH.D.
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Telephone | 714-841-3465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY14709
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License Number State | CA
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