Provider Demographics
NPI:1811434392
Name:BURGOYNE, BRIAN (PSYD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:BURGOYNE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3545
Mailing Address - Country:US
Mailing Address - Phone:248-918-5600
Mailing Address - Fax:
Practice Address - Street 1:10268 W CENTENNIAL RD STE 200C
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-6424
Practice Address - Country:US
Practice Address - Phone:720-443-2943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0006246103TC0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician