Provider Demographics
NPI:1508504408
Name:BOUGHER, SARAH E
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:E
Last Name:BOUGHER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGPC
Mailing Address - Street 1:8108 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4551
Mailing Address - Country:US
Mailing Address - Phone:304-690-3277
Mailing Address - Fax:
Practice Address - Street 1:8108 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4551
Practice Address - Country:US
Practice Address - Phone:304-690-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12614101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional