Jo Ellen M Bourg, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0113601 Issued in NM

Practice address

1911 Main Ave Ste 234
Durango, CO 81301-5077

Phone

(985) 665-8452

NPI assigned

Jan 6, 2009

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

Enrolled in UT, NM, CO3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Mental Health Counselor

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442

  NM, Professional, UT

  Medicare reassignment NPD

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

{
    "created_epoch": "1231200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543795200000",
    "number": "1538305941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 W 25TH ST",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813015908",
            "telephone_number": "985-665-8452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 MAIN AVE STE 234",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813015077",
            "telephone_number": "985-665-8452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURG",
        "first_name": "JO ELLEN",
        "middle_name": "M",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-06",
        "last_updated": "2018-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "0113601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cyril Bohachevsky, M.D.
• Eleanor Bolster, SWC
• Tom D Bonde, LCSW
• Andre Botha, RPT, DIPMDT
• Amy Glaser Bourdon, OT
• Johanna Joy Bowser
• Laurie Boyer, LCSW
• Robert Earl Boyer, M.D.
• Claire Braam, CNP
• John Phillip Brach, M.D.

• Mental Health Counselor in Durango, CO
• Providers in Durango, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.