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General NPI Number Information
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NPI Number | 1154724011
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Entity Type | Individual
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Provider Name | RICHARD GILBERT BURGESS
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Gender | Male
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 10/06/2014
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Provider Practice Location Address
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Address Line | 3125 MYERS ST
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City | RIVERSIDE
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State | CA
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Zip | 92503-5527
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Country | US
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Telephone | 951-374-3516
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Fax |
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Provider Business Mailing Address
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Address Line | 26200 REDLANDS BLVD APT 160
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City | REDLANDS
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State | CA
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Zip | 92373-7781
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Country | US
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Telephone | 909-305-3417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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