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Individual

TAYLOR S BURGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPC-IT

Contact information

Practice address
1612 S 76TH ST APT 104, WEST ALLIS, WI 53214-4690
(414) 334-7061
Mailing address
1612 S 76TH ST APT 104, WEST ALLIS, WI 53214-4690
(414) 334-7061

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5463-226
WI

Other

Enumeration date
10/12/2023
Last updated
10/12/2023
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