Jacqueline Bourassa

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PLC6140 Issued in LA

Practice address

2802 Hodges St
Lake Charles, LA 70601-7368

Phone

(337) 419-1873

Fax

(337) 656-2848

NPI assigned

May 11, 2015

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

Enrolled in LA

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 1

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Counseling Services of Southwest Louisiana IncGroup PAC ID 4981931201, 2 clinicians

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.

• Counseling Services of Southwest Louisiana, Inc.

  • Mental Health Counselor
  • Lake Charles, LA
  • NPI 1831244821
  Medicare reassignment Care Compare group NPD
• Disney & Associates, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lake Charles, LA
  • NPI 1225183213
  NPD (past)
• Elite Medical Wellness LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lake Charles, LA
  • NPI 1346644606
  NPD (past)

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431302400000",
    "number": "1639557606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2802 HODGES ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017368",
            "telephone_number": "337-419-1873",
            "fax_number": "337-656-2848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2802 HODGES ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017368",
            "telephone_number": "337-419-1873",
            "fax_number": "337-656-2848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURASSA",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-11",
        "last_updated": "2015-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "PLC6140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Lyn Boudreaux
• Ryan Earl Boudreaux
• Boudreaux'S New Drug Store, LLC
• Regina Bougie, FNP
• Seth Matthew Boullion, DPT
• Lauren Bourgeois, NP-C
• Reagan Elizabeth Bourgeois, FNP
• Veronica Danielle Bourgeois
• Donna Louise Bourque, RN
• Collin Bowe

• Professional Counselor in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Professional Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2015; 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.