Provider Demographics
NPI:1457006140
Name:BOURGEAU, CELIA LOUISE (MS TLLP)
Entity type:Individual
Prefix:MRS
First Name:CELIA
Middle Name:LOUISE
Last Name:BOURGEAU
Suffix:
Gender:F
Credentials:MS TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1847
Mailing Address - Country:US
Mailing Address - Phone:313-986-1899
Mailing Address - Fax:
Practice Address - Street 1:2633 S LAPEER RD STE G
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-2810
Practice Address - Country:US
Practice Address - Phone:248-270-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009665103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth