Celia Louise Bourgeau, M.S. T.L.L.P.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6362009665 Issued in MI

Practice address

2633 S Lapeer Rd Ste G
Orion, MI 48360-2810

Phone

(248) 270-5660

NPI assigned

Feb 21, 2022

Last updated

Oct 1, 2024By 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 2

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

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.

• Dynamic Life Counseling

  dba Dynamic Wellness Collaborative

  • Clinical Social Worker
  • Orion, MI
  • NPI 1942883236
  NPD

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

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1457006140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1891 OXFORD RD",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482361847",
            "telephone_number": "313-986-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2633 S LAPEER RD STE G",
            "city": "ORION",
            "state": "MI",
            "postal_code": "483602810",
            "telephone_number": "248-270-5660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURGEAU",
        "first_name": "CELIA",
        "middle_name": "LOUISE",
        "name_prefix": "Mrs.",
        "credential": "M.S. T.L.L.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-21",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6362009665",
            "primary": true
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "MI",
            "license": "6362009665",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Orion, MI
• Providers in Orion, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; 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.