Individual provider · NPI-1
Melissa Beth Bouchard
Peer Specialist · Farmington Hills, MI
NPI number1164933396
StatusActive
Last updated in NPPESOct 16, 2017
Details
- NPI
- 1164933396
- Entity type
- Individual (NPI-1)
- Name
- Melissa Beth Bouchard
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 16, 2017
- Last updated
- Oct 16, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 175T00000X | Peer Specialist | – | – | Yes |
| 171W00000X | Contractor | – | – | |
| 172V00000X | Community Health Worker | – | MI |
Practice location
32411 Briarcrest KnlsFarmington Hills, MI 48334-1515
Phone 917-575-0823
Mailing address
32411 Briarcrest KnlsFarmington Hills, MI 48334-1515
Phone 917-575-0823
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