| Doctor Name: | MRS. MARIA VICTORIA BOUSHELLE |
| NPI Number: | 1063811701 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHCA |
| License Number: | MC60426766 |
| Business Practice Address: | 4807 196th St Sw Suite 100 Lynnwood, WA - 980366430 |
| Business Phone Number: | 4257441216 |
| Business Fax Number: | |
| Mailing Address: | Po Box 3810, EVERETT |
| State: | WA |
| Postal Code: | 982138810 |
| Phone Number: | 4253498359 |
| Fax Number: | |
| NPI Enumeration Date: | 08/19/2014 |
| NPI Last Update Date: | 08/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MC60426766 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |