Provider Demographics
NPI:1851427488
Name:BOULLESTER, SAYURI GRACE
Entity Type:Individual
Prefix:
First Name:SAYURI
Middle Name:GRACE
Last Name:BOULLESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-4935
Mailing Address - Country:US
Mailing Address - Phone:541-513-1918
Mailing Address - Fax:
Practice Address - Street 1:1255 PEARL ST STE 102
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3570
Practice Address - Country:US
Practice Address - Phone:541-687-6983
Practice Address - Fax:541-687-2063
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor