Individual
CHARLES A BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
119 PARKER HALL, COLUMBIA, MO 65211-2340
(573) 882-6601
Mailing address
119 PARKER HALL, COLUMBIA, MO 65211-2340
(573) 882-6601
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2019039862
MO
Other
Enumeration date
08/31/2020
Last updated
08/31/2020
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