Provider Demographics
NPI:1699899054
Name:BOUCHARD, CHAD JAMES (MA)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:JAMES
Last Name:BOUCHARD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 NEWLAND ST
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:80214-1020
Mailing Address - Country:US
Mailing Address - Phone:720-273-5292
Mailing Address - Fax:303-432-5262
Practice Address - Street 1:9485 W COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3918
Practice Address - Country:US
Practice Address - Phone:303-432-5274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health