Healthcare Provider Details

I. General information

NPI: 1104226083
Provider Name (Legal Business Name): CATHELINE BOURDEAU LAMOUR MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHELINE BOURDEAU LAMOUR MS

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 MARAVILLA LN
FORT MYERS FL
33901-7221
US

IV. Provider business mailing address

612 SE 31ST TER
CAPE CORAL FL
33904-3549
US

V. Phone/Fax

Practice location:
  • Phone: 239-332-8009
  • Fax: 239-332-4977
Mailing address:
  • Phone: 239-243-0813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: