Provider Demographics
NPI:1992981369
Name:GASS-BOSHOVEN, ELIZABETH ALICE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ALICE
Last Name:GASS-BOSHOVEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5607
Mailing Address - Country:US
Mailing Address - Phone:269-342-1331
Mailing Address - Fax:
Practice Address - Street 1:3021 FLEETWOOD DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5607
Practice Address - Country:US
Practice Address - Phone:269-342-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010218101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor