MEDICARE: LAUREN LEE BOUCHE' L.P.C.

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	101YP2500X	Professional Counselor	2711	CO

General Provider Information

NPI Number	:	1972696201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN LEE BOUCHE' L.P.C.

Provider Business Mailing Address
First Line	:	258 KELLY LN
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80603-9715
Country	:	US
Telephone Number	:	303-807-0267
Fax Number	:	303-655-0730

Provider Business Practice Location Address
First Line	:	360 S MONROE ST
Second Line	:	STE 310
City	:	DENVER
State	:	CO
Zip	:	80209-3705
Country	:	US
Telephone Number	:	303-807-0267
Fax Number	:	303-655-0730

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

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	07/08/2007

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