Mary Lou Bourque, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

000493 Issued in MO

Practice address

763 S New Ballas Rd
Suite 110
Saint Louis, MO 63141-8704

Phone

(314) 569-1717

Fax

(314) 569-0441

NPI assigned

Jul 14, 2005

Last updated

Jul 12, 2007By the provider in NPPES

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

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.

• Psych Care Consultants LLC

  • Psychiatry Physician
  • Saint Louis, MO
  • NPI 1275533853

  Mental Health

  NPD (past)

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184198400000",
    "number": "1750380515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 CEDAR PLAZA PARKWAY",
            "address_2": "STE 350",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283441",
            "telephone_number": "314-843-4333",
            "fax_number": "314-843-4856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "763 S NEW BALLAS RD",
            "address_2": "SUITE 110",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418704",
            "telephone_number": "314-569-1717",
            "fax_number": "314-569-0441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURQUE",
        "first_name": "MARY LOU",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-14",
        "last_updated": "2007-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "000493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittney Bourgeois
• Nancy O Bourgeois, NP-C
• Ashli Bourisaw, OTD
• Amy Bourland, LCSW
• Steve Bourne, PH.D.
• Kelly B Bouse
• McKayla Bouse
• Tayler Boushie
• Julie Bouthillier, RN
• Katherine Lin Bouvatte, MSW, LCSW

• Mental Health Counselor in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Mental Health Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; 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.