| Doctor Name: | DR. WAYNE CHARLES BOUCHER |
| NPI Number: | 1093794372 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D, ABPP |
| License Number: | 1614 |
| Business Practice Address: | Robert E Bush Naval Hosptial Magtftc Mcagcc Twentynine Palms, CA - 922788250 |
| Business Phone Number: | 7608302935 |
| Business Fax Number: | 7608302755 |
| Mailing Address: | Po Box 788250, Magtftc Mcagcc TWENTYNINE PALMS |
| State: | CA |
| Postal Code: | 922788250 |
| Phone Number: | 7608302935 |
| Fax Number: | 7608302755 |
| NPI Enumeration Date: | 01/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1614 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |