Provider Demographics
NPI:1093466567
Name:BURGOS, JAMES ANTONY (LPC NCC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANTONY
Last Name:BURGOS
Suffix:
Gender:M
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-3209
Mailing Address - Country:US
Mailing Address - Phone:318-564-4726
Mailing Address - Fax:
Practice Address - Street 1:725 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-3209
Practice Address - Country:US
Practice Address - Phone:318-564-4726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional