Individual
LISA BOULAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18256 E WILLIAMS FIELD RD, GILBERT, AZ 85295-6801
(480) 356-4370
Mailing address
20211 E VIA DEL ORO, QUEEN CREEK, AZ 85142-6270
(480) 356-4370
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091693
—
AZ
Enumeration date
05/03/2021
Last updated
05/03/2021
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