Douglas Dubois Burgess, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS 13534 Issued in CA

Practice address

1551 Bishop St
Suite a-160
San Luis Obispo, CA 93401-4635

Phone

(805) 269-1500

Fax

(805) 269-1585

NPI assigned

Aug 21, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429574400000",
    "number": "1700992062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8028",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 BISHOP ST",
            "address_2": "SUITE A-160",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014635",
            "telephone_number": "805-269-1500",
            "fax_number": "805-269-1585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "DOUGLAS",
        "middle_name": "DUBOIS",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2015-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 13534",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC71031F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPIN",
            "identifier": "SW13534",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN GROUP",
            "identifier": "W1508",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney N. Bundren
• Jason Bunker, OD
• Jodi Rae Burdick, R.D.A.
• Christine Felicia Burg, NP
• Gabriella Liann Burgess Hayes, MS, CF-SLP
• Denan Yvonne Burke, LMFT
• Justin Burke
• Megan Burkett, FNP
• Krista Burnett
• Rachael L Burrow, M. EDU

• Clinical Social Worker in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.