DR. LEROY BURGESS


Address: 300 S Saint Louis Blvd Ste 202, South Bend, IN 46617-3044
Phone: 5742321405

DR. LEROY BURGESS (NPI# 1528449964) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1528449964
Entity Type Individual
Full Name DR. LEROY BURGESS
Credential PSYCHOLOGIST
Practice Address 300 S Saint Louis Blvd Ste 202
South Bend
IN 46617-3044
Practice Telephone 5742321405
Practice Fax Number 5742320124
Mailing Telephone 5742321405
Mailing Fax Number 5742320124
Enumeration Date 2015-06-11
Last Update Date 2015-06-11
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TH0100X Psychologist
Specialization: Health Service
99066271A IN Behavioral Health & Social Service Providers

Office Location

Street Address 300 S SAINT LOUIS BLVD STE 202
City SOUTH BEND
State IN
Zip Code 46617-3044

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Taxonomy Information

Taxonomy Code 103TH0100X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Health Service

Taxonomy Definition

A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974).
Notes: Source: National Register of Health Service Providers in Psychology website http://www.nationalregister.org/about_NR.html [7/1/2006: modified title, added definition]

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Competitor

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City SOUTH BEND
Zip Code 46617

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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