Provider Demographics
NPI:1053586206
Name:ANDERSEN BURGHER, CAROLYN ANN (MS LMHC LMHP LIMHP)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ANN
Last Name:ANDERSEN BURGHER
Suffix:
Gender:F
Credentials:MS LMHC LMHP LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LOCUST LODGE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503
Mailing Address - Country:US
Mailing Address - Phone:712-328-9205
Mailing Address - Fax:
Practice Address - Street 1:35 MAIN PLACE
Practice Address - Street 2:SUITE 100 OMNI CENTER BUSINESS PARK
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503
Practice Address - Country:US
Practice Address - Phone:712-320-9205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00169101YM0800X
NE1750101YM0800X
NE376101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health