MEDICARE: MR. DARRETT JEROME BURR LMHC, LPC

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	LPC012344	GA
2	101YM0800X	Mental Health Counselor	C6609	OR
3	101YM0800X	Mental Health Counselor	0701010529	VA
4	101YM0800X	Mental Health Counselor	LH60237239	WA

General Provider Information

NPI Number	:	1376859421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARRETT JEROME BURR LMHC, LPC

Provider Business Mailing Address
First Line	:	100 N HOWARD ST STE R
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0508
Country	:	US
Telephone Number	:	206-458-2556
Fax Number	:

Provider Business Practice Location Address
First Line	:	5441 S MACADAM AVE STE R
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3822
Country	:	US
Telephone Number	:	206-458-2556
Fax Number	:

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

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	09/09/2025

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