Provider Demographics
NPI:1043641988
Name:BURG, JOSHUA RYAN (PSYD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RYAN
Last Name:BURG
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 1:1777 S BELLAIRE ST STE 339
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4434
Mailing Address - Country:US
Mailing Address - Phone:720-588-0454
Mailing Address - Fax:
Practice Address - Street 1:1777 S BELLAIRE ST STE 339
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4434
Practice Address - Country:US
Practice Address - Phone:720-588-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO4840103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health