Individual
BRUCE GREGORY BOUDOUSQUIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
43 BASS LN, HOPE, ID 83836-9689
(208) 920-0666
Mailing address
43 BASS LN, HOPE, ID 83836-9689
(208) 920-0666
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC3283
ID
101YP2500X
Professional Counselor
LCPC-2241
MT
Other
Enumeration date
02/06/2008
Last updated
05/13/2016
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