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NPI Code Detail

MEDICARE: LUKE BURROUGHS BS PSYCHOLOGY

MEDICARE: LUKE BURROUGHS BS PSYCHOLOGY
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
1103T00000XPsychologist

General Provider Information

NPI Number : 1063911709
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUKE BURROUGHS BS PSYCHOLOGY
Provider Business Mailing Address
First Line : 2448 ROCKY BROOK ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-4704
Country : US
Telephone Number : 603-748-1968
Fax Number :
Provider Business Practice Location Address
First Line : 2448 ROCKY BROOK ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-4704
Country : US
Telephone Number : 603-748-1968
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2018
Last Update Date : 02/08/2018

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