Provider Demographics
NPI:1295729127
Name:BURGNER, MICHELE E (MSSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:E
Last Name:BURGNER
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 21ST AVE S
Mailing Address - Street 2:SUITE 229
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4942
Mailing Address - Country:US
Mailing Address - Phone:615-298-3010
Mailing Address - Fax:615-298-3011
Practice Address - Street 1:2200 21ST AVE S
Practice Address - Street 2:SUITE 229
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4942
Practice Address - Country:US
Practice Address - Phone:615-298-3010
Practice Address - Fax:615-298-3011
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-25
Provider Licenses
StateLicense IDTaxonomies
TN43441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical