Basic Information
| Provider Information | |||||||||
| NPI: | 1316673858 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOUCHARD | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | CARLTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5982 RHODES RD | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442408100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306731347 | ||||||||
| FaxNumber: | 3306783677 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 N 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439521844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409967100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2022 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | C.2204015-TRNE | OH | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.