Individual provider · Type 1 NPI

Mark Allen Bourassa

Professional Counselor · Stockton, CA

NPI number 1053295204 Active

Practice location

1305 Tommydon St
Stockton, CA 95210-3364

Call (855) 268-4096 Map

Mailing address

1620 G St Apt 17
Sacramento, CA 95814-1632

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor Primary 101YP2500X22719 (CA)

Professional Counselor: Definition to come...

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About NPI 1053295204

Mark Allen Bourassa's National Provider Identifier is 1053295204, issued on Aug 1, 2025. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Stockton, CA. The record was last updated on Aug 4, 2026.