Healthcare Provider Details

I. General information

NPI: 1043366495
Provider Name (Legal Business Name): LENNA BETH BURNETT LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 INDUSTRIAL PARK RD
MONMOUTH IL
61462-9794
US

IV. Provider business mailing address

2323 WINDISH DR
GALESBURG IL
61401-9780
US

V. Phone/Fax

Practice location:
  • Phone: 309-734-9461
  • Fax: 309-734-3909
Mailing address:
  • Phone: 309-344-2323
  • Fax: 309-344-4368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180004706
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: