Healthcare Provider Details

I. General information

NPI: 1053616805
Provider Name (Legal Business Name): ERIC RUSSELL BURNS ED.D., ACD, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 SULLIVAN ST
BAILEY CO
80421-1583
US

IV. Provider business mailing address

224 SULLIVAN ST
BAILEY CO
80421-1583
US

V. Phone/Fax

Practice location:
  • Phone: 720-231-9675
  • Fax:
Mailing address:
  • Phone: 720-231-9675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0015304
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0001867
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: