Individual
JACQUELINE BOURASSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2802 HODGES ST, LAKE CHARLES, LA 70601-7368
(337) 419-1873
(337) 656-2848
Mailing address
2802 HODGES ST, LAKE CHARLES, LA 70601-7368
(337) 419-1873
(337) 656-2848
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PLC6140
LA
Other
Enumeration date
05/11/2015
Last updated
05/11/2015
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