Provider Demographics
NPI:1679591812
Name:BURGE, CARLTON H (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:H
Last Name:BURGE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INNWOOD CIR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2447
Mailing Address - Country:US
Mailing Address - Phone:501-224-6888
Mailing Address - Fax:501-224-6889
Practice Address - Street 1:1 INNWOOD CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2447
Practice Address - Country:US
Practice Address - Phone:501-224-6888
Practice Address - Fax:501-224-6889
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06-08P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X065Medicare ID - Type Unspecified