Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3858 | AZ |
Y | 103T00000X | Psychologist | 3858 | AZ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3858 | AZ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3858 | AZ |
N | 103G00000X | Clinical Psychologist | 3858 | AZ |
N | 103TC0700X | Clinical Psychologist | 3858 | AZ |
N | 103TF0200X | Forensic Psychologist | 3858 | AZ |
N | 103TH0100X | Health Service | 3858 | AZ |
N | 103TR0400X | Rehabilitation Psychologist | 3858 | AZ |
NPI | 1184740144 |
---|---|
Provider Name | Lisa M Burgess |
First Address | Phoenix, AZ 85020-5251 |
Second Address | Phoenix, AZ 85020-5251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 07/04/2008 |