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General NPI Number Information
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NPI Number | 1124084827
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Entity Type | Individual
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Provider Name | REBECCA BARR BOURGEOIS LIC CLIN SOCIAL WORK
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Gender | Female
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Dates
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Enumeration Date | 04/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 901 WHITE ST RUSTON MENTAL HEALTH CENTER
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City | RUSTON
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State | LA
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Zip | 71270
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Country | US
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Telephone | 318-251-4150
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Fax | 318-251-4177
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Provider Business Mailing Address
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Address Line | 112 LAKE POWELL DR
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City | WEST MONROE
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State | LA
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Zip | 71292
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Country | US
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Telephone | 318-396-2459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2664
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License Number State | LA
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