Provider Demographics
NPI:1922724392
Name:BOURGEOIS, LAUREL CHRISTINE (MSSA LISW-S)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:CHRISTINE
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:MSSA LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3337 FENMORE LN
Mailing Address - Street 2:
Mailing Address - City:REMINDERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8186
Mailing Address - Country:US
Mailing Address - Phone:440-724-9059
Mailing Address - Fax:
Practice Address - Street 1:3337 FENMORE LN
Practice Address - Street 2:
Practice Address - City:REMINDERVILLE
Practice Address - State:OH
Practice Address - Zip Code:44202-8186
Practice Address - Country:US
Practice Address - Phone:440-724-9059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1901949-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health