Active NPI
Daniel Burgos, LPC
- Professional Counselor
- Waukegan, IL
National Provider Identifier
1669044392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178010654
- Practice address
- 2255 N. Greenbay Rd.
Waukegan, IL 60087-4274 - Phone
- (224) 285-0728
- NPI assigned
- Jul 13, 2021
- Last updated
- Jul 13, 2021
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178010654 | IL | Primary |
Addresses
Primary practice location
2255 N. Greenbay Rd.
Waukegan, IL 60087-4274
Mailing address
1704 Dusk Dr
Zion, IL 60099-9250
Phone (224) 280-2525
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178010654 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tabularasa Integrative Health Inc | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626134400000",
"number": "1669044392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1704 DUSK DR",
"city": "ZION",
"state": "IL",
"postal_code": "600999250",
"telephone_number": "224-280-2525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2255 N. GREENBAY RD.",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600874274",
"telephone_number": "224-285-0728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGOS",
"first_name": "DANIEL",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-13",
"last_updated": "2021-07-13",
"certification_date": "2021-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178010654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.