CHAD THOMAS BOUSAMRA M.A. NPI 1164694030

NPI Information

  • NPI: 1164694030
  • Provider Name: CHAD THOMAS BOUSAMRA, M.A.
  • Classification: Counselor - 101YA0400X
  • Specialization: Addiction (Substance Use Disorder)
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1105 E EIGHTH ST
    TRAVERSE CITY, MI
    ZIP 49686
  • Phone: (231) 935-6787

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NPI Details

Chad Thomas Bousamra, M.A. is an addiction (substance use disorder) counselor in Traverse City, MI with 19 years of experience. Chad Thomas Bousamra, M.A. NPI is 1164694030. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1105 E EIGHTH ST
TRAVERSE CITY, MI
ZIP 49686-936
Phone: (231) 935-6787
Fax: (231) 935-6920

The NPI 1164694030 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 3/31/2008 and was last updated on 3/31/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YA0400XCounselorAddiction (Substance Use Disorder)6401010758MICHIGANYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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