Provider Demographics
NPI:1023744299
Name:BURGESS, AMBER ARLENE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:ARLENE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 WOODLAND SQUARE LOOP SE STE 401
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1070
Mailing Address - Country:US
Mailing Address - Phone:360-763-5828
Mailing Address - Fax:
Practice Address - Street 1:1570 N NATIONAL AVE STE 216
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2219
Practice Address - Country:US
Practice Address - Phone:360-763-5828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health