Chevelle Marie Bourdon, LCSW 99121

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW99121 Issued in CA

Practice address

13941 Courage St
Moreno Valley, CA 92553-8757

Phone

(951) 653-3000

NPI assigned

Aug 6, 2012

Last updated

Jun 2, 2026By 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 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Immanuel Sobriety Inc.

  dba Immanuel House

  • Substance Abuse Rehabilitation Facility
  • Moreno Valley, CA
  • NPI 1710793807
  NPD
• Immanuel Sobriety Inc.

  dba Immanuel House

  • Substance Abuse Rehabilitation Facility
  • Moreno Valley, CA
  • NPI 1467096818
  NPD (past)
• Immanuel Sobriety Inc.

  dba Immanuel House

  • Substance Abuse Rehabilitation Facility
  • Perris, CA
  • NPI 1558177642
  NPD (past)
• Pathway Society Inc

  • Substance Abuse Rehabilitation Facility
  • San Jose, CA
  • NPI 1346528106
  NPD (past)
• Pathway Society Inc

  • Substance Abuse Rehabilitation Facility
  • San Jose, CA
  • NPI 1386374494
  NPD (past)

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

{
    "created_epoch": "1344211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1447507728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 S ENCINA ST",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932775352",
            "telephone_number": "559-736-5402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13941 COURAGE ST",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925538757",
            "telephone_number": "951-653-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13921 Courage St",
            "address_purpose": "LOCATION",
            "city": "Moreno Valley",
            "state": "CA",
            "postal_code": "925538757",
            "country_code": "US",
            "telephone_number": "951-653-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14340 Elsworth St Ste 108",
            "address_purpose": "LOCATION",
            "city": "Moreno Valley",
            "state": "CA",
            "postal_code": "925539020",
            "country_code": "US",
            "telephone_number": "951-653-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "835 Anira Ct",
            "address_purpose": "LOCATION",
            "city": "Perris",
            "state": "CA",
            "postal_code": "925715113",
            "country_code": "US",
            "telephone_number": "951-653-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURDON",
        "first_name": "CHEVELLE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCSW 99121",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-06",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW99121",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "99121",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gene Booth, CRNA
• Jamie Lynn Booth, PA-C
• Kimberly Gale Borden, MD
• Javier Bordes
• Diwata Hope Abeleda Bose, MD
• Danny Bouz, DO
• Tony Bouz
• Isidra Bowie
• Monique Leeann Bowman
• Marina Boyarsky, M.D.

• Clinical Social Worker in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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.