Provider Demographics
NPI:1508506429
Name:BOURGEOIS, HAYLEY (LMSW)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2249 N LOOP 336 W STE B
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3639
Mailing Address - Country:US
Mailing Address - Phone:936-755-2900
Mailing Address - Fax:
Practice Address - Street 1:2249 N LOOP 336 W STE B
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3639
Practice Address - Country:US
Practice Address - Phone:936-755-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61566104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker