Provider Demographics
NPI:1649300146
Name:BURGESS, KARLA J (LMHP, LPC)
Entity type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:J
Last Name:BURGESS
Suffix:
Gender:F
Credentials:LMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:RED CLOUD
Mailing Address - State:NE
Mailing Address - Zip Code:68970-0465
Mailing Address - Country:US
Mailing Address - Phone:402-746-5614
Mailing Address - Fax:402-746-5684
Practice Address - Street 1:721 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:RED CLOUD
Practice Address - State:NE
Practice Address - Zip Code:68970-2278
Practice Address - Country:US
Practice Address - Phone:402-746-5614
Practice Address - Fax:402-746-5684
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1550OtherPROFESSIONAL COUNSELOR
NE2991OtherMENTAL HEALTH PRACTITIONE
85562OtherBLUE CROSS BLUE SHIELD