Provider Demographics
NPI:1124191945
Name:BOUWHUIS, LMFT, KORINNE K (LMFT)
Entity type:Individual
Prefix:
First Name:KORINNE
Middle Name:K
Last Name:BOUWHUIS, LMFT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W 1400 N.
Mailing Address - Street 2:STE A. LDS FAMILY SERVICES
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341
Mailing Address - Country:US
Mailing Address - Phone:435-752-5302
Mailing Address - Fax:435-753-9007
Practice Address - Street 1:175 W. 1400 N.
Practice Address - Street 2:STE A. LDS FAMILY SERVICES
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341
Practice Address - Country:US
Practice Address - Phone:435-752-5302
Practice Address - Fax:435-753-9007
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5165227-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist