Doctor Name: | JESSICA L. BOULEY |
NPI Number: | 1013257039 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MHRT-C |
License Number: | |
Business Practice Address: | 24 Sweden St Suite #201 Caribou, ME - 047362127 |
Business Phone Number: | 2074933361 |
Business Fax Number: | 2074924889 |
Mailing Address: | 24 Sweden St, Suite #201 CARIBOU |
State: | ME |
Postal Code: | 047362127 |
Phone Number: | 2074933361 |
Fax Number: | 2074924889 |
NPI Enumeration Date: | 02/28/2013 |
NPI Last Update Date: | 08/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |