MEDICARE: DR. MEGAN BOUTINEN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH60576837	WA
2	103T00000X	Psychologist	PY60708359	WA
3	103T00000X	Psychologist	40535	TX

General Provider Information

NPI Number	:	1255780219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN BOUTINEN PH.D.

Provider Business Mailing Address
First Line	:	2802 FLINTROCK TRCE STE 203
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78738-1744
Country	:	US
Telephone Number	:	512-559-3877
Fax Number	:	425-249-3543

Provider Business Practice Location Address
First Line	:	2802 FLINTROCK TRCE STE 203
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78738-1744
Country	:	US
Telephone Number	:	512-559-3877
Fax Number	:	425-249-3543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2016
Last Update Date	:	01/08/2025

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