Provider Demographics
NPI:1679237481
Name:BOU-FITZMAURICE, BLANCA EUGENIA (MS IN COUNSELING)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:EUGENIA
Last Name:BOU-FITZMAURICE
Suffix:
Gender:F
Credentials:MS IN COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5065 AMESBURY DR APT 191
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4628
Mailing Address - Country:US
Mailing Address - Phone:915-234-0565
Mailing Address - Fax:
Practice Address - Street 1:5065 AMESBURY DR APT 191
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206
Practice Address - Country:US
Practice Address - Phone:214-433-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor