Healthcare Provider Details

I. General information

NPI: 1023851037
Provider Name (Legal Business Name): ROBIN MARIE BOURGOYNE PLPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 NORTH BLVD STE A
BATON ROUGE LA
70806-3830
US

IV. Provider business mailing address

1430 SPANISH LAKES AVE
SAINT GABRIEL LA
70776-5331
US

V. Phone/Fax

Practice location:
  • Phone: 225-387-7652
  • Fax:
Mailing address:
  • Phone: 504-655-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: