Provider Demographics
NPI:1427555671
Name:ABUNASRA-BOURLAND, MICHELLE COLETTE (MFT STATE INTERN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:COLETTE
Last Name:ABUNASRA-BOURLAND
Suffix:
Gender:F
Credentials:MFT STATE INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E HORIZON DR STE G
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-8001
Mailing Address - Country:US
Mailing Address - Phone:702-605-2766
Mailing Address - Fax:
Practice Address - Street 1:220 E HORIZON DR STE G
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8001
Practice Address - Country:US
Practice Address - Phone:702-605-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI3124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist