Healthcare Provider Details

I. General information

NPI: 1790600203
Provider Name (Legal Business Name): JUSTIN BURR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CORMORANT WAY
SACRAMENTO CA
95815-2715
US

IV. Provider business mailing address

2252 PEGGY LN
EL DORADO HILLS CA
95762-3810
US

V. Phone/Fax

Practice location:
  • Phone: 916-221-2537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number250109041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: