Provider Demographics
NPI:1427623990
Name:BOURAIMA, GOUNI LAKOSO (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:GOUNI
Middle Name:LAKOSO
Last Name:BOURAIMA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 S OCOTILLO AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-6406
Mailing Address - Country:US
Mailing Address - Phone:520-586-4040
Mailing Address - Fax:
Practice Address - Street 1:335 S OCOTILLO AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6406
Practice Address - Country:US
Practice Address - Phone:520-586-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2581582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry