| Doctor Name: | MR. LYLE SPENCER BOURCY |
| NPI Number: | 1235130162 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCPC |
| License Number: | LCPC-2757 |
| Business Practice Address: | 1303 Nw 16th St Suite C Fruitland, ID - 836192263 |
| Business Phone Number: | 2082500374 |
| Business Fax Number: | 2084522164 |
| Mailing Address: | 1303 Nw 16th St, Suite C FRUITLAND |
| State: | ID |
| Postal Code: | 836192263 |
| Phone Number: | 2082500374 |
| Fax Number: | 2084522164 |
| NPI Enumeration Date: | 08/02/2005 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LCPC-2757 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |