MEDICARE: HAYLEY BOURGEOIS LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	61566	TX

General Provider Information

NPI Number	:	1508506429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYLEY BOURGEOIS LMSW

Provider Business Mailing Address
First Line	:	2249 N LOOP 336 W STE B
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3639
Country	:	US
Telephone Number	:	936-755-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2249 N LOOP 336 W STE B
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3639
Country	:	US
Telephone Number	:	936-755-2900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	03/30/2022

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Directions to “ HAYLEY BOURGEOIS LMSW” Practice Location

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