Individual
DR. LAURA BOURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
7504 WESTPORT RD, LOUISVILLE, KY 40222-4108
(502) 262-2887
Mailing address
1459 STUART ENGALS BLVD, SUITE 204-A, MOUNT PLEASANT, SC 29464-3600
(843) 849-9913
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
266047
KY
103TC0700X
Clinical Psychologist
4901
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100707410
—
KY
Enumeration date
04/11/2017
Last updated
12/08/2020
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