Provider Demographics
NPI:1023001849
Name:BURGESS, DEBORAH (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CROSS ST
Mailing Address - Street 2:111
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4877
Mailing Address - Country:US
Mailing Address - Phone:941-505-6162
Mailing Address - Fax:941-505-8604
Practice Address - Street 1:425 CROSS ST
Practice Address - Street 2:111
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4877
Practice Address - Country:US
Practice Address - Phone:941-505-6162
Practice Address - Fax:941-505-8604
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0361OtherBCBS