Provider Demographics
NPI:1013171305
Name:BOUCHER, JAMEE N (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMEE
Middle Name:N
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 N PORTLAND AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6171
Mailing Address - Country:US
Mailing Address - Phone:405-605-3093
Mailing Address - Fax:
Practice Address - Street 1:4911 N PORTLAND AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6171
Practice Address - Country:US
Practice Address - Phone:405-605-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK46791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor