| Doctor Name: | MR. TEDD MICHAEL BURGASON |
| NPI Number: | 1265771174 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | LPC 2020 |
| Business Practice Address: | 1354 S Lazy Fox Dr Wickenburg, AZ - 853903166 |
| Business Phone Number: | 9282310645 |
| Business Fax Number: | |
| Mailing Address: | 1354 S Lazy Fox Dr, WICKENBURG |
| State: | AZ |
| Postal Code: | 853903166 |
| Phone Number: | 9282310645 |
| Fax Number: | |
| NPI Enumeration Date: | 02/12/2013 |
| NPI Last Update Date: | 02/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC 2020 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |