Elizabeth A Bourg

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

011768899 Issued in LA

Practice address

7932 Summa Ave Ste B2
Baton Rouge, LA 70809-3736

Phone

(225) 349-7171

NPI assigned

Nov 17, 2022

Sex

Female

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

State licenses

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

{
    "created_epoch": "1668643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668643200000",
    "number": "1174232193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5850 GRANITE PKWY STE 600",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750246753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7932 SUMMA AVE STE B2",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708093736",
            "telephone_number": "225-349-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURG",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-17",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "LA",
            "license": "011768899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mikki Smith Bouquet, M.D.
• Ibrahim Bourakba
• Hester Catherine Bourdier, SLP
• Angele D. Bourg, M.D.
• Cheryl Larrieu Bourg, R.PH.
• Mallory Bourg
• Paige Bourg
• Amanda Elizabeth Bourgeois, LPC
• Andrew Paul Bourgeois, M.D.
• Brittany Nichole Bourgeois

• Behavior Technician in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Behavior Technician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.