Provider Demographics
NPI:1104981125
Name:BOURCIER, JEANINE MICHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:MICHELLE
Last Name:BOURCIER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4061 IDAHO ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2530
Mailing Address - Country:US
Mailing Address - Phone:619-228-3354
Mailing Address - Fax:
Practice Address - Street 1:4061 IDAHO ST APT 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2530
Practice Address - Country:US
Practice Address - Phone:619-228-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59420106H00000X
CA51833106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist