Healthcare Provider Details

I. General information

NPI: 1609313790
Provider Name (Legal Business Name): ALYSSA MICHELLE BURTNER PSYD, LCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W HIGGINS RD STE 1250
HOFFMAN ESTATES IL
60169-2051
US

IV. Provider business mailing address

2500 W HIGGINS RD STE 1250
HOFFMAN ESTATES IL
60169-2051
US

V. Phone/Fax

Practice location:
  • Phone: 847-303-1880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178011734
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071010012
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: