Provider Demographics
NPI:1174304497
Name:BOUSQUET, LORIE ANN (LPC)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:ANN
Last Name:BOUSQUET
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LORIE
Other - Middle Name:ANN
Other - Last Name:FEHLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1000 W NIFONG BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5615
Practice Address - Country:US
Practice Address - Phone:573-884-1130
Practice Address - Fax:573-884-5936
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019036868101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health