Provider Demographics
NPI:1235247057
Name:BOURASSA, STELLA VALERIE
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:VALERIE
Last Name:BOURASSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5237 RED BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9341
Mailing Address - Country:US
Mailing Address - Phone:407-758-0808
Mailing Address - Fax:
Practice Address - Street 1:220 LOOKOUT PL STE 150
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-8430
Practice Address - Country:US
Practice Address - Phone:407-834-8776
Practice Address - Fax:407-831-0073
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health