Individual
SHADLYN COX BOURNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
5555 BOONE AVE N, NEW HOPE, MN 55428-3636
(651) 774-0011
(651) 774-0606
Mailing address
3000 AMES CROSSING RD STE 600, EAGAN, MN 55121-2570
(651) 774-0011
(651) 774-0606
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
Primary
2267
MN
101YP2500X
Professional Counselor
Primary
CC2267
MN
Other
Enumeration date
12/23/2019
Last updated
04/08/2026
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