Provider Demographics
NPI:1528367224
Name:BOURGEOIS, MARC B (LPC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:B
Last Name:BOURGEOIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:112 ALMA DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-4787
Mailing Address - Country:US
Mailing Address - Phone:337-501-2624
Mailing Address - Fax:337-482-6747
Practice Address - Street 1:1011 HARDING ST.
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-501-2624
Practice Address - Fax:337-482-6747
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4930101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health