Doctor Name: | MR. RAYMOND H BURGOYNE |
NPI Number: | 1114957396 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 100789-3501 |
Business Practice Address: | 433 S 500 E American Fork, UT - 840032527 |
Business Phone Number: | 8012168000 |
Business Fax Number: | 8012168001 |
Mailing Address: | 343 N 825 E, AMERICAN FORK |
State: | UT |
Postal Code: | 840031952 |
Phone Number: | 8017564619 |
Fax Number: | |
NPI Enumeration Date: | 07/04/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 100789-3501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |