Provider Demographics
NPI:1184090425
Name:BOURGEOIS, JOSHUA (MED, PLPC, NCC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:BOURGEOIS
Suffix:
Gender:M
Credentials:MED, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 KEATING DR
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-1629
Mailing Address - Country:US
Mailing Address - Phone:504-393-5750
Mailing Address - Fax:504-393-5760
Practice Address - Street 1:115 KEATING DR
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-1629
Practice Address - Country:US
Practice Address - Phone:504-393-5750
Practice Address - Fax:504-393-5760
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLPC#5876101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPLPC #5876OtherLPC BOARD