Provider Demographics
NPI:1164156469
Name:BOURGEOIS, BREANNE (LPC)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:
Other - Last Name:OLIVIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2140 ELMCREST WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT GABRIEL
Mailing Address - State:LA
Mailing Address - Zip Code:70776-5354
Mailing Address - Country:US
Mailing Address - Phone:225-287-5122
Mailing Address - Fax:
Practice Address - Street 1:37539 HIGHWAY 427
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3710
Practice Address - Country:US
Practice Address - Phone:225-244-9110
Practice Address - Fax:504-335-0775
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional