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NPI Code Detail

MEDICARE: MRS. KARLA J BURGESS LMHP, LPC

MEDICARE: MRS. KARLA J BURGESS LMHP, LPC
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
1101YM0800XMental Health Counselor2991NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11550OTHERNEPROFESSIONAL COUNSELOR
22991OTHERNEMENTAL HEALTH PRACTITIONE
385562OTHERBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1649300146
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KARLA J BURGESS LMHP, LPC
Provider Business Mailing Address
First Line : PO BOX 465
Second Line :
City : RED CLOUD
State : NE
Zip : 68970-0465
Country : US
Telephone Number : 402-746-5614
Fax Number : 402-746-5684
Provider Business Practice Location Address
First Line : 721 W 6TH AVE
Second Line :
City : RED CLOUD
State : NE
Zip : 68970-2278
Country : US
Telephone Number : 402-746-5614
Fax Number : 402-746-5684
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 07/08/2008

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