Individual
SHYLA ROSE BOUGOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
520 FULLERTON RD, SWANSEA, IL 62226-2901
(618) 910-0606
(618) 257-0641
Mailing address
520 FULLERTON RD, SWANSEA, IL 62226-2901
(314) 246-9441
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
180.015824
IL
101YM0800X
Mental Health Counselor
Primary
180.015824
IL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
180.015824
IL
Other
Enumeration date
08/09/2019
Last updated
01/14/2026
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