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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MARK ALLEN BOURASSA
NPI 1053295204
Counselor - Professional in Stockton, CA

Active since August 01, 2025
1305 TOMMYDON ST, STOCKTON, CA 95210(855) 268-4096 Get Directions Write a Review

NPPES record last updated: August 4, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mark Allen Bourassa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARK ALLEN BOURASSA (NPI 1053295204) is an individual professional provider in Stockton, California, licensed in California (22719) and active in the NPI registry since August 2025.

NPPES Registry Identity

NPI1053295204
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameMARK ALLEN BOURASSA
Location Address1305 TOMMYDON STStockton, CA 95210-3364
Mailing Address1620 G St Apt 17Sacramento, CA 95814-1632 · (916) 857-4451
Phone(855) 268-4096
Sole ProprietorNo
Enumeration DateAugust 1, 2025
Last NPPES UpdateAugust 4, 2026
NPPES CertifiedAugust 4, 2026
✔ NPI 1053295204 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in CA · 22719
1305 TOMMYDON ST, Stockton, CA 95210
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ROBERT PHIL PARK PSY.D.
Psychologist
1305 TOMMYDON ST
STOCKTON, CA 95210
San Joaquin County (209) 476-5211
LINDA LIEM PH.D; LCSW
Social Worker (Clinical)
1305 TOMMYDON ST
STOCKTON, CA 95210
San Joaquin County (209) 476-2015
DR. THU DAN THI PHAM PH.D.
Psychologist
1305 TOMMYDON ST
STOCKTON, CA 95210
San Joaquin County (209) 476-5256
PANHIA LO LMFT
Marriage & Family Therapist
1305 TOMMYDON ST
STOCKTON, CA 95210
San Joaquin County (855) 268-4096
PEGGY LINGARD LCSW
Social Worker (Clinical)
1305 TOMMYDON ST
STOCKTON, CA 95210
San Joaquin County (855) 268-4096
DR. DAVID EUGENE MACE ED.D., MSCP
Psychologist (Clinical)
1305 TOMMYDON ST
STOCKTON, CA 95210
San Joaquin County (209) 476-2015
COLLEEN A RIGGS LMFT
Marriage & Family Therapist
1305 TOMMYDON ST
STOCKTON, CA 95210
San Joaquin County (209) 476-3205
CEFERINA ROSE GARCIA LMFT
Marriage & Family Therapist
1305 TOMMYDON ST
STOCKTON, CA 95210
San Joaquin County (209) 268-4096

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Bourassa's NPI number?

The NPI number for Mark Bourassa is 1053295204. It was assigned to this individual provider in the NPPES registry on August 1, 2025.

Where is Mark Bourassa located?

Mark Bourassa practices at 1305 Tommydon St, Stockton, CA 95210. The listed phone number is (855) 268-4096.

What is Mark Bourassa's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

When was this NPI record last updated?

The NPPES record for Mark Bourassa was last updated on August 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.