Individual
CRYSTAL BOURLIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2314 MIAMI ST, SOUTH BEND, IN 46614-1336
(574) 204-2745
Mailing address
2314 MIAMI ST, SOUTH BEND, IN 46614-1336
(574) 204-2745
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-16-26924
IN
Other
Enumeration date
02/21/2019
Last updated
02/21/2019
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