Provider Demographics
NPI:1710028196
Name:BOURGEOIS, TAMYRA F (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:TAMYRA
Middle Name:F
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 SUPERIOR DR., SUITE C-1
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816
Mailing Address - Country:US
Mailing Address - Phone:225-753-1452
Mailing Address - Fax:225-293-9188
Practice Address - Street 1:5525 SUPERIOR DR STE C1
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8052
Practice Address - Country:US
Practice Address - Phone:225-753-1452
Practice Address - Fax:225-293-9188
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional