Provider Demographics
NPI:1316412398
Name:BURGESS, MADELEINE (LPC)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:
Other - Last Name:LEVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2262
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-2262
Mailing Address - Country:US
Mailing Address - Phone:469-290-2837
Mailing Address - Fax:
Practice Address - Street 1:1225 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-1717
Practice Address - Country:US
Practice Address - Phone:469-290-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional