MEDICARE: DAVID BURGESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1144913120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BURGESS

Provider Business Mailing Address
First Line	:	5549 HIGHWAY K
Second Line	:
City	:	BRIGHTON
State	:	MO
Zip	:	65617-7256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 MCCURRY ST
Second Line	:
City	:	PLEASANT HOPE
State	:	MO
Zip	:	65725-9231
Country	:	US
Telephone Number	:	417-267-7701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2023
Last Update Date	:	05/26/2023

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Directions to “ DAVID BURGESS ” Practice Location

Language	Start Address	Practice Location

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