Provider Demographics
NPI:1265114979
Name:BOUCHER, JACOB RAYMOND DANIEL (BS PSYCHOLOGY)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:RAYMOND DANIEL
Last Name:BOUCHER
Suffix:
Gender:M
Credentials:BS PSYCHOLOGY
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7106 NE 44TH CIR APT A
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3688
Mailing Address - Country:US
Mailing Address - Phone:360-600-9927
Mailing Address - Fax:
Practice Address - Street 1:10604 NE HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-5613
Practice Address - Country:US
Practice Address - Phone:360-644-1631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor