Provider Demographics
NPI:1609835131
Name:BOURNE, MARGARET (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:
Last Name:BOURNE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E PUGH DR
Mailing Address - Street 2:SUITE 16
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3942
Mailing Address - Country:US
Mailing Address - Phone:812-243-2741
Mailing Address - Fax:812-448-4040
Practice Address - Street 1:1400 E PUGH DR
Practice Address - Street 2:SUITE 16
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3942
Practice Address - Country:US
Practice Address - Phone:812-243-2741
Practice Address - Fax:812-448-4040
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist