Ashley Nicole Bourg, LCSW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

52561 Issued in TX

Practice address

2002 Holcombe Blvd
Houston, TX 77030-4211

Phone

(281) 455-1031

NPI assigned

Apr 7, 2021

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1801475553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 LONGWOOD GLEN LN",
            "city": "FRIENDSWOOD",
            "state": "TX",
            "postal_code": "775461502",
            "telephone_number": "281-455-1031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 HOLCOMBE BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304211",
            "telephone_number": "281-455-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURG",
        "first_name": "ASHLEY",
        "middle_name": "NICOLE",
        "credential": "LCSW-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-07",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "52561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9999999",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Houston",
            "affiliation": "N",
            "endpointDescription": "Michael Debakey VA hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2002 Holcombe Blvd",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770304211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bounce Rehabilitation and Wellness LLC
• Boundaries & Balance Therapy, PLLC
• Faye L. Bounds, CNM
• Jerry E Bouquot, DDS
• Katelynn Anne Bourassa, PHD
• Bourgeois Investment Group Inc
• Clarissa M Bourgeois, M.ED, LPC
• Jeremy Bourgeois, PT, DPT
• Keith Alan Bourgeois, M.D.
• Kelly Bourgeois, M.D.

• Clinical Social Worker in Houston, TX
• Providers in Houston, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; 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.