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Individual

DR. LEROY BURGESS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSYCHOLOGIST

Contact information

Practice address
300 S SAINT LOUIS BLVD STE 202, SOUTH BEND, IN 46617-3044
(574) 232-1405
(574) 232-0124
Mailing address
300 S SAINT LOUIS BLVD STE 202, SOUTH BEND, IN 46617-3044
(574) 232-1405
(574) 232-0124

Taxonomy

Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
99066271A
IN

Other

Enumeration date
06/11/2015
Last updated
06/11/2015
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