Healthcare Provider Details

I. General information

NPI: 1144913120
Provider Name (Legal Business Name): DAVID BURGESS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MCCURRY ST
PLEASANT HOPE MO
65725-9231
US

IV. Provider business mailing address

5549 HIGHWAY K
BRIGHTON MO
65617-7256
US

V. Phone/Fax

Practice location:
  • Phone: 417-267-7701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: