Individual
MR. MITCHELL ALLEN BOUSSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 N 9TH ST, MODESTO, CA 95350-5814
(209) 558-4598
Mailing address
900 N 9TH ST, MODESTO, CA 95350-4723
(209) 558-4598
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95273030
CA
Other
Enumeration date
01/19/2024
Last updated
01/19/2024
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