Provider Demographics
NPI:1821669508
Name:BOUCHER, COURTNEY VAN HOUTEN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:VAN HOUTEN
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WICKS END LN
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2633
Mailing Address - Country:US
Mailing Address - Phone:475-289-8054
Mailing Address - Fax:
Practice Address - Street 1:5 WICKS END LN
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2633
Practice Address - Country:US
Practice Address - Phone:203-293-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002604106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist