Individual
LISA BOUMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LMFT
Contact information
Practice address
4320 44TH ST SW, SUITE 103, GRANDVILLE, MI 49418-2300
(616) 890-0883
Mailing address
4310 LEONARD ST NW, SUITE 103, GRAND RAPIDS, MI 49534
(616) 453-6329
(616) 453-1725
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
4101006210
MI
Other
Enumeration date
02/23/2006
Last updated
01/06/2010
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