Healthcare Provider Details

I. General information

NPI: 1629388772
Provider Name (Legal Business Name): MICHAEL GENE BURNS LPCC, BIP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503B DARBY CREEK RD
LEXINGTON KY
40509-1603
US

IV. Provider business mailing address

503B DARBY CREEK RD
LEXINGTON KY
40509-1603
US

V. Phone/Fax

Practice location:
  • Phone: 859-687-5843
  • Fax: 502-324-3210
Mailing address:
  • Phone: 859-687-5843
  • Fax: 502-324-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number105712
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number170523
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2505
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1093
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number105712
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: