Provider Demographics
NPI:1689699332
Name:BURGER, MICHELLE RENEE (LMHP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENEE
Last Name:BURGER
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 EAST 22ND STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FREEMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025
Mailing Address - Country:US
Mailing Address - Phone:402-721-8805
Mailing Address - Fax:
Practice Address - Street 1:230 EAST 22ND STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:FREEMONT
Practice Address - State:NE
Practice Address - Zip Code:68025
Practice Address - Country:US
Practice Address - Phone:402-721-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELMHP2117101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078839726Medicaid
NE099595Medicare ID - Type Unspecified