Bourque, Mary Lou

Bourque, Mary Lou is an individual health care provider with primary practice located at 763 S New Ballas Rd Suite 110, Saint Louis MO 63141-8704. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Bourque, Mary Lou can be contacted via phone (314) 569-1717.

Contact Information

Primary practice address
763 S New Ballas Rd Suite 110 Saint Louis MO 63141-8704
Phone: (314) 569-1717
Fax: (314) 569-0441
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 000493 Missouri

Profile Details

NPI number 1750380515
LBN Legal business name Bourque, Mary Lou
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2005
Last updated Jul 12th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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