Provider Demographics
NPI:1225801160
Name:BURGESS, ALISON M
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:M
Last Name:BURGESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S 40TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1626
Mailing Address - Country:US
Mailing Address - Phone:479-202-8040
Mailing Address - Fax:
Practice Address - Street 1:501 S 40TH ST STE 101
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1626
Practice Address - Country:US
Practice Address - Phone:479-202-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health