Healthcare Provider Details

I. General information

NPI: 1528641396
Provider Name (Legal Business Name): CHARLENE ARNITIA BURROWS STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 S WESTERN AVE
CHICAGO IL
60643-4732
US

IV. Provider business mailing address

11740 S WESTERN AVE
CHICAGO IL
60643-4732
US

V. Phone/Fax

Practice location:
  • Phone: 312-241-3761
  • Fax:
Mailing address:
  • Phone: 405-626-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.021961
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: