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General NPI Number Information
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NPI Number | 1396354536
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Entity Type | Individual
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Provider Name | DAVE BURGOON LPCC
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Gender | Male
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 668 BYPASS RD
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City | BRANDENBURG
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State | KY
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Zip | 40108-1730
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Country | US
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Telephone | 270-305-1820
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Fax |
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Provider Business Mailing Address
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Address Line | 87 ROLLING CT
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City | EKRON
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State | KY
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Zip | 40117-8649
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Country | US
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Telephone | 270-305-1820
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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 | 263815
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License Number State | KY
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