Provider Demographics
NPI:1316515315
Name:BOUSHELE, AVA KATHERINE
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:KATHERINE
Last Name:BOUSHELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5522 LONE STAR PKWY BUILDING 1 STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6719
Mailing Address - Country:US
Mailing Address - Phone:213-670-8028
Mailing Address - Fax:
Practice Address - Street 1:8151 SOUTHPARK LN UNIT 100
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4502
Practice Address - Country:US
Practice Address - Phone:720-642-7019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician