Provider Demographics
NPI:1346644788
Name:BOURNER COUNSELING SERVICES
Entity Type:Organization
Organization Name:BOURNER COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-739-0230
Mailing Address - Street 1:100 S IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2644
Mailing Address - Country:US
Mailing Address - Phone:208-453-4378
Mailing Address - Fax:208-452-4378
Practice Address - Street 1:100 S IOWA AVE
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2644
Practice Address - Country:US
Practice Address - Phone:208-453-4378
Practice Address - Fax:208-452-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC5147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDID3857OtherSTATE OF IDAHO