Active NPI
Marci Sondra Burroughs, PHD
- Counseling Psychologist
- Knoxville, TN
National Provider Identifier
1578094140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 2109
- Practice address
- 9111 Cross Park Dr Suite E111
Knoxville, TN 37923-4506 - Phone
- (865) 696-7332
- Fax
- (865) 761-8198
- NPI assigned
- Mar 24, 2017
- Last updated
- Jun 21, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 2109 | TN | Primary |
Addresses
Primary practice location
9111 Cross Park Dr Suite E111
Knoxville, TN 37923-4506
Mailing address
118 N Peters Rd Ste 155
Knoxville, TN 37923-4927
Phone (865) 696-7332
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 20, 2022 through May 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2109 | TN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624233600000",
"number": "1578094140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 N PETERS RD STE 155",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379234927",
"telephone_number": "865-696-7332",
"fax_number": "865-761-8198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9111 CROSS PARK DR SUITE E111",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379234506",
"telephone_number": "865-696-7332",
"fax_number": "865-761-8198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURROUGHS",
"first_name": "MARCI",
"middle_name": "SONDRA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-24",
"last_updated": "2021-06-21",
"certification_date": "2021-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "TN",
"license": "2109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.