Provider Demographics
NPI:1023572484
Name:BOURGOIN, LESLIE CATHERINE OLIVIA (LMHC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:CATHERINE OLIVIA
Last Name:BOURGOIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4526 FEDERAL AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2132
Mailing Address - Country:US
Mailing Address - Phone:425-349-6200
Mailing Address - Fax:
Practice Address - Street 1:4807 196TH ST SW STE 220
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6409
Practice Address - Country:US
Practice Address - Phone:425-835-5850
Practice Address - Fax:425-835-5855
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60158756101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health