| Doctor Name: | MR. DAVID LYNN BOURNE |
| NPI Number: | 1669702643 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS LPC |
| License Number: | 4216 |
| Business Practice Address: | 100 E Ray Fine Blvd Roland, OK - 749545198 |
| Business Phone Number: | 9174271311 |
| Business Fax Number: | 9184270013 |
| Mailing Address: | Po Box 378, ROLAND |
| State: | OK |
| Postal Code: | 749540378 |
| Phone Number: | 9174271311 |
| Fax Number: | 9184270013 |
| NPI Enumeration Date: | 01/13/2010 |
| NPI Last Update Date: | 01/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 4216 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |