Healthcare Provider Details

I. General information

NPI: 1023639952
Provider Name (Legal Business Name): CAITLIN LILAH ROLLINS BURT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 N 95TH AVE STE 160
PHOENIX AZ
85037-4313
US

IV. Provider business mailing address

9947 W LOUISE DR
PEORIA AZ
85383-3314
US

V. Phone/Fax

Practice location:
  • Phone: 602-540-8492
  • Fax:
Mailing address:
  • Phone: 385-227-5726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-21989
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: