Healthcare Provider Details

I. General information

NPI: 1255573978
Provider Name (Legal Business Name): STEVE BOURNE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY BLVD DEPT. OF PSYCHOLOGY, UNIVERSITY OF MISSOURI-ST. LOUIS
SAINT LOUIS MO
63121-4400
US

IV. Provider business mailing address

1 UNIVERSITY BLVD DEPT. OF PSYCHOLOGY, UNIVERSITY OF MISSOURI-ST. LOUIS
SAINT LOUIS MO
63121-4400
US

V. Phone/Fax

Practice location:
  • Phone: 314-516-5824
  • Fax: 314-516-5347
Mailing address:
  • Phone: 314-516-5824
  • Fax: 314-516-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2009004846
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: