Provider Demographics
NPI:1447847918
Name:KHOURY-BOUCHER, ALISHA HELEN (MED, LADC I, CADC)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:HELEN
Last Name:KHOURY-BOUCHER
Suffix:
Gender:F
Credentials:MED, LADC I, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 KINGSLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2711
Mailing Address - Country:US
Mailing Address - Phone:413-530-0741
Mailing Address - Fax:
Practice Address - Street 1:21 KINGSLEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2711
Practice Address - Country:US
Practice Address - Phone:413-530-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)