1720164742 NPI number — MRS. MARGARET AMANDA BURTS MSW, LCSW

Table of content: MRS. MARGARET AMANDA BURTS MSW, LCSW (NPI 1720164742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720164742 NPI number — MRS. MARGARET AMANDA BURTS MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTS
Provider First Name:
MARGARET
Provider Middle Name:
AMANDA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
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:
1720164742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
468 CALER RD
Provider Second Line Business Mailing Address:
P.O. BOX 173
Provider Business Mailing Address City Name:
BRASSTOWN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28902-8532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-837-9761
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
281 VALLEY RIVER AVENUE
Provider Second Line Business Practice Location Address:
MURPHY COUNSELING SERVICES
Provider Business Practice Location Address City Name:
MURPHY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-835-7372
Provider Business Practice Location Address Fax Number:
828-835-8282
Provider Enumeration Date:
10/31/2006

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: 1041C0700X , with the licence number:  C002825 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: CSW003183 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 6002577 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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