Provider Demographics
NPI:1770176224
Name:BOURASSA, MICHELLE LEE (MA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:BOURASSA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 LILLIAN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-7029
Mailing Address - Country:US
Mailing Address - Phone:603-313-0698
Mailing Address - Fax:
Practice Address - Street 1:736 LILLIAN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-7029
Practice Address - Country:US
Practice Address - Phone:603-313-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health