Coty Bourque, LCSW in Vicksburg, MS - Medicare Social Worker Provider

Coty Bourque, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Vicksburg, Mississippi. His current practice location is 1911 Mission 66 Ste B, Vicksburg, Mississippi. You can reach out to his office (for appointments etc.) via phone at (337) 519-7797.

Coty Bourque is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1356850960.

Contact Information

	Coty Bourque, LCSW
	1911 Mission 66 Ste B, Vicksburg, MS 39180-3762
	(337) 519-7797
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Coty Bourque
Gender	Male
Speciality	Social Worker - Clinical
Location	1911 Mission 66 Ste B, Vicksburg, Mississippi
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1356850960
Provider Enumeration Date: 09/26/2017
Last Update Date: 05/13/2025

Medicare PECOS Information:

PECOS PAC ID: 1557739745
Enrollment ID: I20221118001570

Medical Identifiers

Medical identifiers for Coty Bourque such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1356850960	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1041C0700X	Social Worker - Clinical	(* (Not Available))	Primary
101YM0800X	Counselor - Mental Health	(* (Not Available))	Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Coty Bourque allows following entities to bill medicare on his behalf.

Entity Name	Grand River Hospital District
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1124074042 PECOS PAC ID: 7113837469 Enrollment ID: O20040310000898

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Coty Bourque is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Coty Bourque, LCSW 1413 Willow St, New Iberia, LA 70560-1066 Ph: (337) 519-7797	Coty Bourque, LCSW 1911 Mission 66 Ste B, Vicksburg, MS 39180-3762 Ph: (337) 519-7797

Reviews and Comments

Social Worker in Vicksburg, MS

Kayla Moriarty, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 1911 Mission 66 Ste B, Vicksburg, MS 39180 Phone: 601-665-4162 Fax: 855-830-3484
Anna Adcock, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 1911 Mission 66 Ste B, Vicksburg, MS 39180 Phone: 601-665-4162 Fax: 855-830-3484
Kathleen Chappelear, LCSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 1911 Mission 66 Ste B, Vicksburg, MS 39180 Phone: 601-665-4162
Mr. Billy Foster, LCSW, NCC AP MAC Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 109 Alfred Dr, Vicksburg, MS 39180 Phone: 601-415-9424
Carey Martin, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 1911 Mission 66 Ste B, Vicksburg, MS 39180 Phone: 601-665-4162 Fax: 855-830-3484
Mrs. Annette Bryant, LCSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 1107 Openwood St, Vicksburg, MS 39183 Phone: 601-831-4402 Fax: 601-206-0672

Coty Bourque, LCSW - Medicare Clinical Social Worker in Vicksburg, MS