Individual
CHARLIE ELIZA BOUTILLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC MA
Contact information
Practice address
200 ROSS AVE, ALAMOSA, CO 81101-2451
(719) 589-2786
Mailing address
200 ROSS AVE, ALAMOSA, CO 81101-2451
(719) 589-2786
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1725
CO
Other
Enumeration date
03/15/2007
Last updated
09/18/2024
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