Provider Demographics
NPI:1740668516
Name:BOUGHER, ERIN (MA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BOUGHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:NORTHERN CAMBRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15714-1143
Mailing Address - Country:US
Mailing Address - Phone:814-948-5885
Mailing Address - Fax:
Practice Address - Street 1:119 WALNUT ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1625
Practice Address - Country:US
Practice Address - Phone:814-534-0745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor