Provider Demographics
NPI:1912371980
Name:BOUDIN, JONATHAN M (MED, LMHCA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:BOUDIN
Suffix:
Gender:M
Credentials:MED, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 LINCOLN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-6279
Mailing Address - Country:US
Mailing Address - Phone:604-788-1710
Mailing Address - Fax:360-647-6719
Practice Address - Street 1:1329 LINCOLN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6279
Practice Address - Country:US
Practice Address - Phone:604-788-1710
Practice Address - Fax:360-647-6719
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60601851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health