Provider Demographics
NPI:1457838989
Name:BOURQUE, MICHELE NORDGREN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:NORDGREN
Last Name:BOURQUE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 S LINCOLN
Mailing Address - Street 2:STE 100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201
Mailing Address - Country:US
Mailing Address - Phone:360-819-9318
Mailing Address - Fax:
Practice Address - Street 1:4329 CONCORDIA LANE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-819-9318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60472487103TF0000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily