Provider Demographics
NPI:1184941130
Name:BOUGERE, ALAN ACHILLE (PHD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ACHILLE
Last Name:BOUGERE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 FULLER ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7544
Mailing Address - Country:US
Mailing Address - Phone:601-266-6119
Mailing Address - Fax:601-266-4167
Practice Address - Street 1:1914 FULLER ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7544
Practice Address - Country:US
Practice Address - Phone:601-266-6119
Practice Address - Fax:601-266-4167
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC25901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical