Provider Demographics
NPI:1124547575
Name:BOURGOIN, RACHEL JOYE
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:JOYE
Last Name:BOURGOIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:JOYE
Other - Last Name:PHALAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4320
Mailing Address - Country:US
Mailing Address - Phone:720-507-1573
Mailing Address - Fax:
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4320
Practice Address - Country:US
Practice Address - Phone:720-507-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002741106H00000X
TX205728106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist