Provider Demographics
NPI:1063811701
Name:BOUSHELLE, MARIA VICTORIA (LMHCA)
Entity type:Individual
Prefix:MRS
First Name:MARIA VICTORIA
Middle Name:
Last Name:BOUSHELLE
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:MARIA VICTORIA
Other - Middle Name:
Other - Last Name:TENORIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98213-8810
Mailing Address - Country:US
Mailing Address - Phone:425-349-8359
Mailing Address - Fax:
Practice Address - Street 1:4807 196TH ST SW
Practice Address - Street 2:SUITE 100
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6430
Practice Address - Country:US
Practice Address - Phone:425-744-1216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60426766101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health