Basic Information
| Provider Information | |||||||||
| NPI: | 1861079717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOURNIA | ||||||||
| FirstName: | LYNN | ||||||||
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| Credential: | LPCC, PLMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28753 COUNTY ROAD 56 | ||||||||
| Address2: | |||||||||
| City: | ILIFF | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807369634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705710195 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 POLE CREEK XING | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691622901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3082545825 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2021 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LPCC.0017221 | CO | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 12409 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.