Provider Demographics
NPI:1205950185
Name:BURGET, AMANDA J (BA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:BURGET
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 E LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5348
Mailing Address - Country:US
Mailing Address - Phone:814-946-5411
Mailing Address - Fax:
Practice Address - Street 1:400 LAKEMONT PARK BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5947
Practice Address - Country:US
Practice Address - Phone:814-943-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor