MEDICARE: BRITTNEY BOURNE LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	03860	KS
2	101YP2500X	Professional Counselor	72825	MT

General Provider Information

NPI Number	:	1770265589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTNEY BOURNE LCPC

Provider Business Mailing Address
First Line	:	5817 GOHEEN DR
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66503-2654
Country	:	US
Telephone Number	:	319-939-7773
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 COLLEGE AVE BLDG A
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2770
Country	:	US
Telephone Number	:	785-775-0221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	03/18/2026

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Directions to “ BRITTNEY BOURNE LCPC” Practice Location

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