Jennifer Bourquin, LPC
Individual provider Active NPI Professional Counselor · Bastrop, TX
NPI 1790062875 · NPPES record last updated Nov 3, 2011
Key facts
- NPI
- 1790062875
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 65653 (TX)
- Practice address
- 717 Chestnut St
Bastrop, TX 78602-3202 - Phone
- (512) 772-0775
- NPI assigned
- Nov 3, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65653 | TX | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 65653 | TX | Yes |
Addresses
Primary practice location
717 Chestnut St
Bastrop, TX 78602-3202
Mailing address
9017 Laurel Grove Dr.
Austin, TX 78758
Phone (512) 612-2361
Other providers in Bastrop, TX
- Olivia Yvette Blankenship
- Ryan Christopher Bliss
- Bluebonnet Home Health Care of Texas, Inc.
- Bluebonnet OB GYN
- Brandyn K. Bolling
- Mark Ellen Bowles
- Maria A Sandra Brady
- Lesley Marie Bragg
- Brainwell Psychiatry and Mental Health PLLC
- Ashley Brancato
All providers in Bastrop, TX · Professional Counselor in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.