Provider Demographics
NPI:1306105465
Name:BOURQUIN, NICOLE MARIE (MS, LMFT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:BOURQUIN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23232 PERALTA DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1443
Mailing Address - Country:US
Mailing Address - Phone:949-285-9827
Mailing Address - Fax:949-488-2418
Practice Address - Street 1:23232 PERALTA DR
Practice Address - Street 2:SUITE 211
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1443
Practice Address - Country:US
Practice Address - Phone:949-285-9827
Practice Address - Fax:949-488-2418
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46728106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist