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NPI Code Detail

MEDICARE: JANNIFER L BOUCHER LPC

MEDICARE: JANNIFER L BOUCHER LPC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLCAC 107KS
2101YP2500XProfessional CounselorLPC 864KS

General Provider Information

NPI Number : 1588994800
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANNIFER L BOUCHER LPC
Provider Business Mailing Address
First Line : 1905 19TH ST
Second Line :
City : GREAT BEND
State : KS
Zip : 67530-2502
Country : US
Telephone Number : 620-792-5700
Fax Number : 620-792-5742
Provider Business Practice Location Address
First Line : 1905 19TH ST
Second Line :
City : GREAT BEND
State : KS
Zip : 67530-2502
Country : US
Telephone Number : 620-792-5700
Fax Number : 620-792-5742
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2010
Last Update Date : 04/14/2015

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Directions to “ JANNIFER L BOUCHER LPC” Practice Location

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