Provider Demographics
NPI:1578939336
Name:BURGESS-MICHAK, COURTNEY (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:BURGESS-MICHAK
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:HARVEYS LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18618
Mailing Address - Country:US
Mailing Address - Phone:570-592-0266
Mailing Address - Fax:570-255-5509
Practice Address - Street 1:1846 MEMORIAL HIGHWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708
Practice Address - Country:US
Practice Address - Phone:570-592-0266
Practice Address - Fax:570-255-5509
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional