Provider Demographics
NPI:1104927540
Name:BURMEISTER, ROBERT J (LCPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BURMEISTER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2401
Mailing Address - Country:US
Mailing Address - Phone:217-788-9999
Mailing Address - Fax:217-788-9976
Practice Address - Street 1:923 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2401
Practice Address - Country:US
Practice Address - Phone:217-788-9999
Practice Address - Fax:217-788-9976
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
08432104OtherBLUE CROSS BLUE SHIELD
689325OtherHEATHLINK