Provider Demographics
NPI:1578941266
Name:BOUTIN, RENEE NICOLE (MS)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:NICOLE
Last Name:BOUTIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:HAZEL
Other - Middle Name:
Other - Last Name:BOUTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:16535 SW TUALATIN VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-5143
Mailing Address - Country:US
Mailing Address - Phone:503-259-3155
Mailing Address - Fax:
Practice Address - Street 1:16535 SW TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-5143
Practice Address - Country:US
Practice Address - Phone:503-259-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health