Provider Demographics
NPI:1801918800
Name:BOURGEOIS, LELINDA ANNE II
Entity type:Individual
Prefix:
First Name:LELINDA
Middle Name:ANNE
Last Name:BOURGEOIS
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 LAKE OTIS PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5227
Mailing Address - Country:US
Mailing Address - Phone:907-762-2815
Mailing Address - Fax:
Practice Address - Street 1:4045 LAKE OTIS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5227
Practice Address - Country:US
Practice Address - Phone:907-762-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health