Provider Demographics
NPI:1932855608
Name:BOULAY, MEAGEN (LMFT)
Entity Type:Individual
Prefix:
First Name:MEAGEN
Middle Name:
Last Name:BOULAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MEAGEN
Other - Middle Name:
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 292353
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92329-2353
Mailing Address - Country:US
Mailing Address - Phone:760-533-0442
Mailing Address - Fax:
Practice Address - Street 1:11090 DE ANZA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-1826
Practice Address - Country:US
Practice Address - Phone:760-533-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT109452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health