Provider Demographics
NPI:1699844795
Name:BOURA, CRAIG K (MA, LCPC)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:K
Last Name:BOURA
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 MAIN ST
Mailing Address - Street 2:SUITE 28
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3447
Mailing Address - Country:US
Mailing Address - Phone:630-474-4780
Mailing Address - Fax:
Practice Address - Street 1:6912 MAIN ST
Practice Address - Street 2:SUITE 28
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3447
Practice Address - Country:US
Practice Address - Phone:630-474-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-5835474OtherEIN