Individual
MRS. BONNIE BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10801 LOMAS BLVD NE STE 105, ALBUQUERQUE, NM 87112-5474
(505) 620-9785
Mailing address
PO BOX 11068, ALBUQUERQUE, NM 87192-0068
(505) 620-9785
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0065142
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12349
LOVELACE HEALTH PLAN
NM
Enumeration date
10/11/2006
Last updated
07/08/2007
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