Provider Demographics
NPI:1235375726
Name:BOURGEOIS, STEPHANIE NASH (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NASH
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5442
Mailing Address - Country:US
Mailing Address - Phone:985-624-4978
Mailing Address - Fax:985-727-1015
Practice Address - Street 1:1212 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5442
Practice Address - Country:US
Practice Address - Phone:985-624-4978
Practice Address - Fax:985-727-1015
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S504OtherMEDICARE