MEDICARE: ALISON G BURGESS MFT

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
1	106H00000X	Marriage & Family Therapist	3599	FL
2	106H00000X	Marriage & Family Therapist	2122	TN
3	106H00000X	Marriage & Family Therapist	.0001711	CO

General Provider Information

NPI Number	:	1154980704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON G BURGESS MFT

Provider Business Mailing Address
First Line	:	1960 MADISON ST STE J
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-8039
Country	:	US
Telephone Number	:	727-873-0650
Fax Number	:

Provider Business Practice Location Address
First Line	:	1960 MADISON ST STE J
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-8039
Country	:	US
Telephone Number	:	727-873-0650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2019
Last Update Date	:	01/20/2026

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