Provider Demographics
NPI:1184068546
Name:BURGUS, TRACEY (LMHC)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:BURGUS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-5261
Mailing Address - Country:US
Mailing Address - Phone:319-208-1280
Mailing Address - Fax:
Practice Address - Street 1:205 WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-5261
Practice Address - Country:US
Practice Address - Phone:319-208-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health