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Individual

HALEIGH E BOUSLOG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
12345 UNIVERSITY AVE STE 310, CLIVE, IA 50325-8285
(515) 329-0213
Mailing address
12345 UNIVERSITY AVE STE 310, CLIVE, IA 50325-8285

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YM0800X
Mental Health Counselor
Primary
085210
IA

Other

Enumeration date
01/25/2016
Last updated
10/12/2021
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