1649300146 NPI number — MRS. KARLA J BURGESS LMHP, LPC

Table of content: MRS. KARLA J BURGESS LMHP, LPC (NPI 1649300146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649300146 NPI number — MRS. KARLA J BURGESS LMHP, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURGESS
Provider First Name:
KARLA
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHP, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649300146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 465
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED CLOUD
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68970-0465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-746-5614
Provider Business Mailing Address Fax Number:
402-746-5684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 W 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED CLOUD
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68970-2278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-746-5614
Provider Business Practice Location Address Fax Number:
402-746-5684
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  2991 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1550 . This is a "PROFESSIONAL COUNSELOR" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 2991 . This is a "MENTAL HEALTH PRACTITIONE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 85562 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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