Individual
COTY BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1911 MISSION 66 STE B, VICKSBURG, MS 39180-3762
(337) 519-7797
Mailing address
1413 WILLOW ST, NEW IBERIA, LA 70560-1066
(337) 519-7797
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
09/26/2017
Last updated
05/13/2025
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