MEDICARE: DORINDA L BURNHAM LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1124499454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORINDA L BURNHAM LMHC

Provider Business Mailing Address
First Line	:	6817 SOUTHPOINT PKWY STE 1904
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6299
Country	:	US
Telephone Number	:	42-807-3009
Fax Number	:	904-212-2729

Provider Business Practice Location Address
First Line	:	6817 SOUTHPOINT PKWY STE 1904
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6299
Country	:	US
Telephone Number	:	904-280-7300
Fax Number	:	904-212-2729

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	10/06/2021

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