MEDICARE: ANGELICA BURGESS

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	101YP2500X	Professional Counselor	87093	TX

General Provider Information

NPI Number	:	1376397562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA BURGESS

Provider Business Mailing Address
First Line	:	8205 MID CITIES BLVD STE 300
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76182-4719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6344 DAVIS BLVD STE 300
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-4762
Country	:	US
Telephone Number	:	817-701-0663
Fax Number	:	817-752-4101

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

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	04/19/2026

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Directions to “ ANGELICA BURGESS ” Practice Location

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