Individual
ASHLEY NICOLE BOURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW-S
Contact information
Practice address
2002 HOLCOMBE BLVD, HOUSTON, TX 77030-4211
(281) 455-1031
Mailing address
1604 LONGWOOD GLEN LN, FRIENDSWOOD, TX 77546-1502
(281) 455-1031
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
52561
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9999999
—
TX
Enumeration date
04/07/2021
Last updated
04/07/2021
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