Active NPI
Corinne Boulger, MA
- Marriage & Family Therapist
- Tustin, CA
National Provider Identifier
1801453410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 148911
- Practice address
- 250 El Camino Real Ste 213
Tustin, CA 92780-3656 - Phone
- (714) 367-4299
- NPI assigned
- May 20, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 104316 | CA | |
| Marriage & Family Therapist | 106H00000X | 148911 | CA | Primary |
Addresses
Primary practice location
250 El Camino Real Ste 213
Tustin, CA 92780-3656
Mailing address
250 El Camino Real Ste 213
Tustin, CA 92780-3656
Phone (714) 367-4299
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 23, 2024 through Aug 23, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 148911 | CA | MD | Marriage & Family Therapist |
| 104316 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724371200000",
"number": "1801453410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 EL CAMINO REAL STE 213",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803656",
"telephone_number": "714-367-4299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 EL CAMINO REAL STE 213",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803656",
"telephone_number": "714-367-4299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULGER",
"first_name": "CORINNE",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-20",
"last_updated": "2024-08-23",
"certification_date": "2024-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "104316",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "148911",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.