Individual
JODI DIONNE BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-MH
Contact information
Practice address
EAST HWY 18, PINE RIDGE, SD 57770
(605) 867-3062
Mailing address
EAST HWY 18, PO BOX 1201, PINE RIDGE, SD 57770
(605) 867-3062
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-MH2146
SD
Other
Enumeration date
04/14/2008
Last updated
04/14/2008
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