Individual
MARY LOU BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
763 S NEW BALLAS RD, SUITE 110, SAINT LOUIS, MO 63141-8704
(314) 569-1717
(314) 569-0441
Mailing address
5000 CEDAR PLAZA PARKWAY, STE 350, SAINT LOUIS, MO 63128-3441
(314) 843-4333
(314) 843-4856
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
000493
MO
Other
Enumeration date
07/14/2005
Last updated
07/12/2007
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