Provider Demographics
NPI:1710207139
Name:BOURGEOIS, NICOLE (LMFT)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7093
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-7093
Mailing Address - Country:US
Mailing Address - Phone:985-293-7401
Mailing Address - Fax:985-293-7840
Practice Address - Street 1:801 BARROW ST
Practice Address - Street 2:SUITE 313
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4764
Practice Address - Country:US
Practice Address - Phone:985-293-7401
Practice Address - Fax:985-293-7840
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist