Provider Demographics
NPI:1780343731
Name:SUSIE BOUCHER LLC
Entity type:Organization
Organization Name:SUSIE BOUCHER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARISA
Authorized Official - Last Name:BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:251-316-0060
Mailing Address - Street 1:3925 SPRING HILL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-5730
Mailing Address - Country:US
Mailing Address - Phone:251-316-0060
Mailing Address - Fax:251-316-0062
Practice Address - Street 1:3925 SPRING HILL AVE STE B
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-5730
Practice Address - Country:US
Practice Address - Phone:251-316-0060
Practice Address - Fax:251-316-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty