Provider Demographics
NPI:1134156037
Name:BOUVIER, CONSTANCE R (PHD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:R
Last Name:BOUVIER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:16052 BEACH BLVD, STE 228
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649
Mailing Address - Country:US
Mailing Address - Phone:714-841-3465
Mailing Address - Fax:714-841-1882
Practice Address - Street 1:16052 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3850
Practice Address - Country:US
Practice Address - Phone:714-841-3465
Practice Address - Fax:714-841-1882
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1147289363A00000X
CAPSY14709103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant