Basic Information
| Provider Information | |||||||||
| NPI: | 1538471370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURGUET | ||||||||
| FirstName: | IAIN | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 N ELM AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631192418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149615718 | ||||||||
| FaxNumber: | 3149181521 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 N ELM AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631192418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149615718 | ||||||||
| FaxNumber: | 3149181521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2010 | ||||||||
| LastUpdateDate: | 02/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | 2010001234 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.