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General NPI Number Information
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NPI Number | 1558661041
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Entity Type | Organization
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Legal Business Name | KATHRYN A.BOURKE, PSY. D., INC.
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Dates
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Enumeration Date | 10/30/2010
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 436 W 20TH ST
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City | MERCED
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State | CA
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Zip | 95340-3714
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Country | US
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Telephone | 209-384-8808
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2743
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City | MERCED
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State | CA
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Zip | 95344-0743
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Country | US
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Telephone | 209-384-8808
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. KATHRYN A. BOURKE
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Credential | PSY. D.
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Telephone | 209-384-8808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PSY 16571
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 16571
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License Number State | CA
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