Individual
WANDA BURLESON BOUCHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, NCC
Contact information
Practice address
2589 S FIVE MILE RD, BOISE, ID 83709-2325
(208) 991-2301
Mailing address
2982 E HEARTLEAF LN, BOISE, ID 83716-5065
(208) 949-6720
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-5859
ID
Other
Enumeration date
07/05/2017
Last updated
08/12/2019
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