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General NPI Number Information
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NPI Number | 1932855608
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Entity Type | Individual
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Provider Name | MEAGEN BOULAY LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/22/2022
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 11090 DE ANZA RD
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City | VICTORVILLE
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State | CA
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Zip | 92392-1826
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Country | US
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Telephone | 760-533-0442
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 292353
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City | PHELAN
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State | CA
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Zip | 92329-2353
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Country | US
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Telephone | 760-533-0442
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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 | LMFT109452
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License Number State | CA
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