Provider Demographics
NPI:1831253848
Name:BOSCHEN, DAVID M (MFT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:BOSCHEN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 SCOTTS VALLEY DR STE E
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4541
Mailing Address - Country:US
Mailing Address - Phone:831-688-7167
Mailing Address - Fax:
Practice Address - Street 1:4340 SCOTTS VALLEY DR STE E
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4541
Practice Address - Country:US
Practice Address - Phone:831-688-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT27049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT27049OtherLIC