Healthcare Provider Details

I. General information

NPI: 1154149052
Provider Name (Legal Business Name): COURTNEY BURNS CPC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5426 VEGAS DR
LAS VEGAS NV
89108-2403
US

IV. Provider business mailing address

916 CAMBRIDGE CROSS PL
LAS VEGAS NV
89144-1342
US

V. Phone/Fax

Practice location:
  • Phone: 702-806-5268
  • Fax:
Mailing address:
  • Phone: 702-296-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCI5470
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: