Provider Demographics
NPI:1861519381
Name:BOUSQUET, DONNA ELLEN
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:ELLEN
Last Name:BOUSQUET
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 1:825 EAST ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-4976
Mailing Address - Country:US
Mailing Address - Phone:530-668-6769
Mailing Address - Fax:530-668-4010
Practice Address - Street 1:825 EAST ST
Practice Address - Street 2:SUITE 124
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-4976
Practice Address - Country:US
Practice Address - Phone:530-668-6769
Practice Address - Fax:530-668-4010
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor