MEDICARE: GARY BURGE JR.

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	LMFT-15572	AZ

General Provider Information

NPI Number	:	1609243021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY BURGE JR.

Provider Business Mailing Address
First Line	:	504 W 29TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-3353
Country	:	US
Telephone Number	:	520-838-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 S SCOTT AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85701-1919
Country	:	US
Telephone Number	:	520-884-8470
Fax Number	:

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

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	03/16/2021

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Directions to “ GARY BURGE JR. ” Practice Location

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