Active NPI
Mark Lynn Boucher, LMFT
- Marriage & Family Therapist
- Modesto, CA
National Provider Identifier
1538283569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC20703
- Practice address
- 1208 9TH St
Modesto, CA 95354-0713 - Phone
- (209) 558-4464
- Fax
- (209) 558-4450
- NPI assigned
- Mar 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC20703 | CA | Primary |
Addresses
Primary practice location
1208 9TH St
Modesto, CA 95354-0713
Mailing address
1208 9TH St
Modesto, CA 95354-0713
Phone (209) 558-4464
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106H00000X | Other | CA | LMFT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC20703 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1538283569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1208 9TH ST",
"city": "MODESTO",
"state": "CA",
"postal_code": "953540713",
"telephone_number": "209-558-4464",
"fax_number": "209-558-4450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1208 9TH ST",
"city": "MODESTO",
"state": "CA",
"postal_code": "953540713",
"telephone_number": "209-558-4464",
"fax_number": "209-558-4450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCHER",
"first_name": "MARK",
"middle_name": "LYNN",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC20703",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LMFT",
"identifier": "106H00000X",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.