Provider Demographics
NPI:1669702643
Name:BOURNE, DAVID LYNN (MS LPC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LYNN
Last Name:BOURNE
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3017 S 70TH ST STE G
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5000
Mailing Address - Country:US
Mailing Address - Phone:479-210-2146
Mailing Address - Fax:479-222-6895
Practice Address - Street 1:3017 S 70TH ST STE G
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5000
Practice Address - Country:US
Practice Address - Phone:479-210-2146
Practice Address - Fax:479-222-6895
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4216101YP2500X
ARP1803032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional