Provider Demographics
NPI:1528084563
Name:BURGOYNE, MOJIE A (LCSW, LPC, LMFT, ACC)
Entity type:Individual
Prefix:MS
First Name:MOJIE
Middle Name:A
Last Name:BURGOYNE
Suffix:
Gender:F
Credentials:LCSW, LPC, LMFT, ACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 167
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377
Mailing Address - Country:US
Mailing Address - Phone:281-351-2461
Mailing Address - Fax:281-351-9158
Practice Address - Street 1:701 W. MAIN
Practice Address - Street 2:SUITE 2
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:281-351-2461
Practice Address - Fax:281-351-9158
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2176101YP2500X
TX002101041C0700X
TX91106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00534MMedicare ID - Type Unspecified
UR58836-2PMedicare UPIN