Provider Demographics
NPI:1578941266
Name:BOUTIN, RENEE NICOLE (MS)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:NICOLE
Last Name:BOUTIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:HAZEL
Other - Middle Name:
Other - Last Name:BOUTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:1904 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1146
Mailing Address - Country:US
Mailing Address - Phone:971-940-8846
Mailing Address - Fax:
Practice Address - Street 1:1904 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1146
Practice Address - Country:US
Practice Address - Phone:971-940-8846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor