Provider Demographics
NPI:1699580399
Name:BURGESS, CHESLIE NICOLE
Entity type:Individual
Prefix:
First Name:CHESLIE
Middle Name:NICOLE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3182 COLCHESTER CIR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-8265
Mailing Address - Country:US
Mailing Address - Phone:615-915-8522
Mailing Address - Fax:
Practice Address - Street 1:101 TENNESSEE WAY STE 400
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3160
Practice Address - Country:US
Practice Address - Phone:629-255-0339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician