Kelly Marie Bourque, LMFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

769 Issued in TN

Practice address

108 4TH Ave S Ste 205
Franklin, TN 37064-2676

Phone

(615) 594-2830

NPI assigned

Jul 20, 2019

Last updated

Jul 20, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Red Therapy Group

  • Professional Counselor
  • Franklin, TN
  • NPI 1811852817
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563580800000",
    "number": "1033762844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 LANES END DR",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370675101",
            "telephone_number": "615-594-2830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 4TH AVE S STE 205",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370642676",
            "telephone_number": "615-594-2830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURQUE",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-20",
        "last_updated": "2019-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TN",
            "license": "769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan Clare Bosse, OTR/L
• Catherine McCreary Botes, LMFT (TEMP)
• Hilary Susan Boucher, OTR
• Tommy Gene Bourgeois II, PA-C
• Kaylyn Bourne
• Stephanie Bourque, DPH
• Courtney Nicole Bowers, CCC-SLP
• Sasha Louise Bowers, MD
• Kristyn Boyd, PT
• Tanner S Boyd, MD

• Mental Health Counselor in Franklin, TN
• Providers in Franklin, TN by specialty
• Mental Health Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.