| Doctor Name: | MRS. CARLA SUE BOURNE |
| NPI Number: | 1144374612 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., L.B.P. |
| License Number: | 0072 |
| Business Practice Address: | 3103 E Jackson St Hugo, OK - 747434051 |
| Business Phone Number: | 5803265279 |
| Business Fax Number: | |
| Mailing Address: | 173 W Ruth Ave, ATOKA |
| State: | OK |
| Postal Code: | 745254001 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/22/2007 |
| NPI Last Update Date: | 04/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 0072 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |