Provider Demographics
NPI:1194156810
Name:BURG, BOBBI (LCSW)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:
Last Name:BURG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 NE DEERBROOK TER
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6774
Mailing Address - Country:US
Mailing Address - Phone:816-536-7431
Mailing Address - Fax:
Practice Address - Street 1:305 SW MARKET ST # 8
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2388
Practice Address - Country:US
Practice Address - Phone:816-702-8778
Practice Address - Fax:816-203-4499
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MO2013020399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health