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General NPI Number Information
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NPI Number | 1952103426
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Entity Type | Individual
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Provider Name | MICHAEL BOURNSTEIN LPC
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Gender | Male
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 3324 RUE ROYALE ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-8321
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Country | US
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Telephone | 314-287-6267
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Fax |
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Provider Business Mailing Address
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Address Line | 3405 SUBLETTE ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-8250
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Country | US
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Telephone | 314-799-6872
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2021018630
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License Number State | MO
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