Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Coty Bourque, LCSW

Individual provider Clinical Social Worker · NPI 1356850960

Coty Bourque, LCSW is a Clinical Social Worker in Vicksburg, Mississippi. Qualified in 2020, 6 years ago. Practices with Mdb Behavioral Health Services LLC, a 197-clinician group and accepts Medicare assignment.

Years since qualifying
6
In the registry since
2017
Specialties on file
2
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

1911 Mission 66 Ste B
Vicksburg, MS 39180-3762
Phone: (337) 519-7797
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X
Mental Health Counselor Taxonomy 101YM0800X

Record details

NPI number1356850960
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorNo
NPI enumeratedSeptember 26, 2017
Last updated in NPPESMay 13, 2025
Certification dateMay 13, 2025
Mailing address1413 Willow St, New Iberia, LA 70560-1066

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Mdb Behavioral Health Services Llc — 197 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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