Healthcare Provider Details

I. General information

NPI: 1194156810
Provider Name (Legal Business Name): BOBBI BURG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SW MARKET ST # 8
LEES SUMMIT MO
64063-2388
US

IV. Provider business mailing address

1023 NE DEERBROOK TER
LEES SUMMIT MO
64086-6774
US

V. Phone/Fax

Practice location:
  • Phone: 816-702-8778
  • Fax: 816-203-4499
Mailing address:
  • Phone: 816-536-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2013020399
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: