Provider Demographics
NPI:1366165862
Name:BOUCHER, RACHEL (LMHCA, CSAYC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:LMHCA, CSAYC
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:
Other - Last Name:BOUCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHCA, CSAYC
Mailing Address - Street 1:9330 SAN JACINTO DR APT D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1280
Mailing Address - Country:US
Mailing Address - Phone:317-441-1542
Mailing Address - Fax:
Practice Address - Street 1:23 S 8TH ST STE 500
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2637
Practice Address - Country:US
Practice Address - Phone:317-207-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001488A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health