Provider Demographics
NPI:1124547575
Name:BOURGOIN, RACHEL JOYE
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:JOYE
Last Name:BOURGOIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:JOYE
Other - Last Name:PHALAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1891
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7720 BLUE WATER DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-8534
Practice Address - Country:US
Practice Address - Phone:619-322-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101947106H00000X
CO13992106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist