Provider Demographics
NPI:1154980704
Name:BURGESS, ALISON G (MFT)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:G
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 MADISON ST STE J
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8039
Mailing Address - Country:US
Mailing Address - Phone:727-873-0650
Mailing Address - Fax:
Practice Address - Street 1:1375 LEAF LN
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-2549
Practice Address - Country:US
Practice Address - Phone:727-873-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3599106H00000X
TN2122106H00000X
CO.0001711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty