Healthcare Provider Details

I. General information

NPI: 1174304497
Provider Name (Legal Business Name): LORIE ANN BOUSQUET LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORIE ANN FEHLING

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W NIFONG BLVD STE 300
COLUMBIA MO
65203-5615
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-1130
  • Fax: 573-884-5936
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2019036868
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019036868
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: