Provider Demographics
NPI:1699018382
Name:BOUVIER, TONYARAE CATHERINE (PLMHP MSW)
Entity Type:Individual
Prefix:
First Name:TONYARAE
Middle Name:CATHERINE
Last Name:BOUVIER
Suffix:
Gender:F
Credentials:PLMHP MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1890
Mailing Address - Country:US
Mailing Address - Phone:402-679-2611
Mailing Address - Fax:
Practice Address - Street 1:1413 SOUTH WASHINGTON STREET SUITE 300
Practice Address - Street 2:KVC BEHAVIORAL HEALTH
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046
Practice Address - Country:US
Practice Address - Phone:402-885-1859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE98181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical