Jordin Leigh Bourque, LMSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LMSW-18617 Issued in AZ

Practice address

3943 W Griswold Rd
Phoenix, AZ 85051-4633

Phone

(928) 925-5251

NPI assigned

Oct 18, 2021

Last updated

Oct 18, 2021By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

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.

• Pathways to Connection, LLC

  • Clinical Social Worker
  • Peoria, AZ
  • NPI 1396334157
  Medicare reassignment NPD

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

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634515200000",
    "number": "1861155780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3943 W GRISWOLD RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850514633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3943 W GRISWOLD RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850514633",
            "telephone_number": "928-925-5251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURQUE",
        "first_name": "JORDIN",
        "middle_name": "LEIGH",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-18",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LMSW-18617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boundless Light, PLLC
• Anne Bourgeois, NPC
• Megan Bourgeois, BSN RN
• Caroline Bourland
• Christi S. Bourne, M.D.
• Dante Bousley
• Marcia Bouton, PA-C
• Erin Elizabeth Bovee, MED, BCBA, LBA
• Tess G Bowden
• Lisa Kay Bowdoin

• Mental Health Counselor in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.