Provider Demographics
NPI:1942352927
Name:GOURNEAU, CAROL (LMSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:GOURNEAU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL ROAD
Mailing Address - Street 2:BOX 160
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0160
Mailing Address - Country:US
Mailing Address - Phone:701-477-8437
Mailing Address - Fax:701-477-8410
Practice Address - Street 1:1 HOSPITAL ROAD
Practice Address - Street 2:BOX 160
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-0160
Practice Address - Country:US
Practice Address - Phone:701-477-8437
Practice Address - Fax:701-477-8410
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND26811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND01063Medicaid
ND01063Medicaid