Doctor Name: | JODI DIONNE BOURNE |
NPI Number: | 1144494949 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC-MH |
License Number: | LPC-MH2146 |
Business Practice Address: | East Hwy 18 Pine Ridge, SD - 57770 |
Business Phone Number: | 6058673062 |
Business Fax Number: | |
Mailing Address: | East Hwy 18, Po Box 1201 PINE RIDGE |
State: | SD |
Postal Code: | 57770 |
Phone Number: | 6058673062 |
Fax Number: | |
NPI Enumeration Date: | 04/14/2008 |
NPI Last Update Date: | 04/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC-MH2146 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |