Provider Demographics
NPI:1205133832
Name:BURGESS, STARR (MA, NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:STARR
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E PECAN ST
Mailing Address - Street 2:STE 300 PMB 282
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-8048
Mailing Address - Country:US
Mailing Address - Phone:512-673-2192
Mailing Address - Fax:
Practice Address - Street 1:821 GRAND AVENUE PKWY
Practice Address - Street 2:BLDG 1, STE 108
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2196
Practice Address - Country:US
Practice Address - Phone:512-673-2192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64128101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional