Individual
JO ELLEN M BOURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1911 MAIN AVE STE 234, DURANGO, CO 81301-5077
(985) 665-8452
Mailing address
190 W 25TH ST, DURANGO, CO 81301-5908
(985) 665-8452
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0113601
NM
Other
Enumeration date
01/06/2009
Last updated
12/03/2018
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