Tina Han Bouillion, MS, CADC II, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C3283 Issued in OR

Practice address

333 NE Russell St Ste 209
Portland, OR 97212-3762

Phone

(971) 291-0626

Fax

(458) 224-0137

NPI assigned

Feb 25, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nova Counseling and Consulting LLC

  • Professional Counselor
  • Portland, OR
  • NPI 1033678461
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1043450406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5304 SE 44TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972065737",
            "telephone_number": "971-291-0626",
            "fax_number": "458-224-0137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 NE RUSSELL ST STE 209",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123762",
            "telephone_number": "971-291-0626",
            "fax_number": "458-224-0137"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "421 SW Oak St Ste 520",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972041810",
            "country_code": "US",
            "telephone_number": "503-988-8469",
            "fax_number": "503-988-3328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUILLION",
        "first_name": "TINA",
        "middle_name": "HAN",
        "name_prefix": "Mrs.",
        "credential": "MS, CADC II, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-25",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C3283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500762021",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mason Clark Boucher
• Melissa Kay Boucher, DO
• Ashley Nicole Boudet, N.D.
• Eilis Ann Boudreau, MD
• Elizabeth Jean Boudreau, PA-C
• Tyler James Boulanger
• Boulder Care Provider Group PA
• Conor Boulger
• Tyler Dallin Boulter, MD
• Ann Bouma

• Professional Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.