Healthcare Provider Details

I. General information

NPI: 1417860255
Provider Name (Legal Business Name): JOLIE BOUREK MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 FANNIN ST STE 3.286
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

13208 DAUPHINE ST
AUSTIN TX
78727-3271
US

V. Phone/Fax

Practice location:
  • Phone: 832-325-7131
  • Fax:
Mailing address:
  • Phone: 512-566-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number24362
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: