MEDICARE: DR. CARLTON H BURGE PSY.D

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	103TC0700X	Clinical Psychologist	06-08P	AR

General Provider Information

NPI Number	:	1679591812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLTON H BURGE PSY.D

Provider Business Mailing Address
First Line	:	1 INNWOOD CIR
Second Line	:	SUITE 103
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-2447
Country	:	US
Telephone Number	:	501-224-6888
Fax Number	:	501-224-6889

Provider Business Practice Location Address
First Line	:	1 INNWOOD CIR
Second Line	:	SUITE 103
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-2447
Country	:	US
Telephone Number	:	501-224-6888
Fax Number	:	501-224-6889

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	08/06/2007

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