Healthcare Provider Details

I. General information

NPI: 1801633045
Provider Name (Legal Business Name): EMILY R BOURNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ALAMEDA BLVD
LAS CRUCES NM
88005-2621
US

IV. Provider business mailing address

2702 TOPLEY AVE
LAS CRUCES NM
88005-1334
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-9496
  • Fax:
Mailing address:
  • Phone: 575-642-0065
  • 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: