| Doctor Name: | JAMIE C BOUGE |
| NPI Number: | 1154560282 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RC |
| License Number: | RC00053867 |
| Business Practice Address: | 165 E Hawthorne Ave Colville, WA - 991142629 |
| Business Phone Number: | 5096844597 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1120, REPUBLIC |
| State: | WA |
| Postal Code: | 991661120 |
| Phone Number: | 5097753341 |
| Fax Number: | |
| NPI Enumeration Date: | 02/12/2009 |
| NPI Last Update Date: | 02/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | RC00053867 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |