Individual
MEGAN BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4795 BROADWAY, GARY, IN 46409
(219) 887-3688
(219) 887-2666
Mailing address
4795 BROADWAY, GARY, IN 46409-2403
(219) 887-3688
(219) 887-2666
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
33005040A
IN
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87000928A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87000928A
LCAC LICENSE
IN
Enumeration date
09/16/2015
Last updated
09/16/2015
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