Provider Demographics
NPI:1538471370
Name:BURGUET, IAIN DOUGLAS (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:IAIN
Middle Name:DOUGLAS
Last Name:BURGUET
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N ELM AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2418
Mailing Address - Country:US
Mailing Address - Phone:314-961-5718
Mailing Address - Fax:314-918-1521
Practice Address - Street 1:110 N ELM AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2418
Practice Address - Country:US
Practice Address - Phone:314-961-5718
Practice Address - Fax:314-918-1521
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MO2010001234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator