Provider Demographics
NPI:1629203823
Name:BOUTWELL, CHRISTEN DAWN (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTEN
Middle Name:DAWN
Last Name:BOUTWELL
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25482 SERAPHIM CT
Mailing Address - Street 2:
Mailing Address - City:LOXLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36551-7522
Mailing Address - Country:US
Mailing Address - Phone:251-377-2533
Mailing Address - Fax:251-960-1154
Practice Address - Street 1:25482 SERAPHIM CT
Practice Address - Street 2:
Practice Address - City:LOXLEY
Practice Address - State:AL
Practice Address - Zip Code:36551-7522
Practice Address - Country:US
Practice Address - Phone:251-377-2533
Practice Address - Fax:251-960-1154
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-09-5061103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst