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Individual
MR. THOMAS A. BURGESS
Active
Individual
MR. THOMAS A. BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701002576
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040768
VALUE OPTINS PROVIDER NUM
VA
01
—
221239
ANTHEM PROVIDER NUMBER
VA
Enumeration date
01/24/2007
Last updated
07/08/2007
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