Individual
KRYSTYN BOURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, PLPC
Contact information
Practice address
306 W JUDGE PEREZ DR, CHALMETTE, LA 70043-4904
(504) 656-4333
Mailing address
5705 CANAL BLVD, NEW ORLEANS, LA 70124-2814
(504) 266-1013
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PLC9446
LA
Other
Enumeration date
10/22/2024
Last updated
10/22/2024
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