Provider Demographics
NPI:1821545781
Name:BURGESS, STEPHANIE LOIS I (MS)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:LOIS
Last Name:BURGESS
Suffix:I
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:LOIS
Other - Last Name:BURGESS
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:201 W SPRINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5158
Mailing Address - Country:US
Mailing Address - Phone:865-637-9711
Mailing Address - Fax:
Practice Address - Street 1:600 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-6405
Practice Address - Country:US
Practice Address - Phone:865-523-8695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health