MEDICARE: EGYPT C BURGE LPCC

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	101YM0800X	Mental Health Counselor	E.2202812	OH

General Provider Information

NPI Number	:	1942754874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EGYPT C BURGE LPCC

Provider Business Mailing Address
First Line	:	12600 ROCKSIDE RD # 303
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-4525
Country	:	US
Telephone Number	:	216-543-1194
Fax Number	:

Provider Business Practice Location Address
First Line	:	13110 SHAKER SQ # C200-E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2373
Country	:	US
Telephone Number	:	216-201-9696
Fax Number	:

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

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	03/26/2022

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Directions to “ EGYPT C BURGE LPCC” Practice Location

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