MEDICARE: MR. JONATHAN MARK BURG MA, LMFT

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	35001736A	IN

General Provider Information

NPI Number	:	1750678173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN MARK BURG MA, LMFT

Provider Business Mailing Address
First Line	:	15214 DRY CREEK RD
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-4642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15214 DRY CREEK RD
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-4642
Country	:	US
Telephone Number	:	317-645-7691
Fax Number	:

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

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	04/15/2016

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