Matthew Bourne, MS COUNSELING

Primary specialty

CounselorTaxonomy code 101Y00000X

License

88000436A Issued in IN

Practice address

2506 Willowbrook Pkwy Ste 102
Indianapolis, IN 46205-1542

Phone

(317) 803-2270

Fax

(317) 217-1769

NPI assigned

Jun 27, 2017

Sex

Male

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1124548433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 N TILLOTSON AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473043988",
            "telephone_number": "765-288-1928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2506 WILLOWBROOK PKWY STE 102",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462051542",
            "telephone_number": "317-803-2270",
            "fax_number": "317-217-1769"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5794 Waterstone Way",
            "address_purpose": "LOCATION",
            "city": "Whitestown",
            "state": "IN",
            "postal_code": "46075",
            "country_code": "US",
            "telephone_number": "225-610-2213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURNE",
        "first_name": "MATTHEW",
        "credential": "MS COUNSELING",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IN",
            "license": "88000436A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Boulous, MD
• Jennifer Bouman
• Bounce Back Physical Therapy
• Bourke Homecare LLC
• Shawn L Bourke, NP
• Vincent M Bournique, MD
• Kristen Bourque, RD, LD, CLC
• Alexandria Bousamra-Wright, APRN
• John Steven Bousamra
• Elizabeth Bouse, D.C.

• Counselor in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.