| Burgess Psychological, Inc. | |
|
1910 Huntington Dr South Pasadena CA 91030-4812 | |
| (626) 441-6111 | |
| (626) 441-6389 |
| Full Name | Burgess Psychological, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1910 Huntington Dr, South Pasadena, California |
| Authorized Official Name and Position | Manny Burgess (PRESIDENT) |
| Authorized Official Contact | 6264416111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Burgess Psychological, Inc. 1910 Huntington Dr South Pasadena CA 91030-4812 Ph: (626) 441-6111 | Burgess Psychological, Inc. 1910 Huntington Dr South Pasadena CA 91030-4812 Ph: (626) 441-6111 |
| NPI Number | 1801102132 |
|---|---|
| Provider Enumeration Date | 08/24/2010 |
| Last Update Date | 08/24/2010 |
| Medicare PECOS PAC ID | 3375668072 |
|---|---|
| Medicare Enrollment ID | O20100918000073 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801102132 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | PSY10843 (California) | Primary |
| Provider Name | Manny Burgess |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013080290 PECOS PAC ID: 9638203961 Enrollment ID: I20100823000119 |
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