Charles R Burgett, LMFT

Key facts

NPI

1336307487

Entity type

Individual (NPI type 1)

Primary specialty

Marriage & Family Therapist 106H00000X

License

KY-0662 (KY)

Practice address

410 E 11TH Ave
Bowling Green, KY 42101-2637

Phone

(270) 779-4271

NPI assigned

May 27, 2008

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 27, 2008.

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211846400000",
    "number": "1336307487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8074 RUSSELLVILLE RD",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421017337",
            "telephone_number": "270-779-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 E 11TH AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421012637",
            "telephone_number": "270-779-4271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGETT",
        "first_name": "CHARLES",
        "middle_name": "R",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-27",
        "last_updated": "2008-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "KY",
            "license": "KY-0662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

• Jonathan Bunnell, OD
• Fallon Burch, LPCC
• John T Burch, M.D.
• Tyler Burger, LCADC
• Dylan Boyd Burgess, PHARM.D.
• Ryan Burke, TLBA
• Katelyn Burkhart, CDO SUPPORT BROKER
• Janie Marie Burnett, BCBA
• Jerhett Burney, APSS
• Kyra Ann Burns

All providers in Bowling Green, KY · Marriage & Family Therapist in Kentucky