Provider Demographics
NPI:1205578408
Name:BOURGEOIS, KENDRALYN (LPC-A)
Entity type:Individual
Prefix:MS
First Name:KENDRALYN
Middle Name:
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8019 W. GRAND PKWY S, PO BOX 201
Mailing Address - Street 2:STE 1060
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407
Mailing Address - Country:US
Mailing Address - Phone:202-607-2022
Mailing Address - Fax:
Practice Address - Street 1:4606 FM 1960 RD W STE 370
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4613
Practice Address - Country:US
Practice Address - Phone:202-607-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88212101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional