Provider Demographics
NPI:1265792147
Name:MAUGANS, BURTON THOMAS (EDS, LPC)
Entity type:Individual
Prefix:MR
First Name:BURTON
Middle Name:THOMAS
Last Name:MAUGANS
Suffix:
Gender:M
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5684 N SHORES WAY NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4279
Mailing Address - Country:US
Mailing Address - Phone:678-462-3434
Mailing Address - Fax:
Practice Address - Street 1:5684 N SHORES WAY NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4279
Practice Address - Country:US
Practice Address - Phone:678-462-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional