Provider Demographics
NPI:1649686700
Name:BURGOS, JOAN ELIZABETH (MA, LMHC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ELIZABETH
Last Name:BURGOS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-6514
Mailing Address - Country:US
Mailing Address - Phone:319-936-5007
Mailing Address - Fax:
Practice Address - Street 1:1230 PARKER ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6514
Practice Address - Country:US
Practice Address - Phone:319-936-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA118433101YM0800X
OK3053781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical