Provider Demographics
NPI:1023350824
Name:BURGESON, DONNA KAY (LPC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:KAY
Last Name:BURGESON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18301 N WALLACE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65240-3307
Mailing Address - Country:US
Mailing Address - Phone:573-823-0720
Mailing Address - Fax:
Practice Address - Street 1:18301 N WALLACE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:MO
Practice Address - Zip Code:65240-3307
Practice Address - Country:US
Practice Address - Phone:573-823-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013007073101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional