Healthcare Provider Details

I. General information

NPI: 1043502685
Provider Name (Legal Business Name): KELLI DAWN BURNS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLI DAWN GEORGE

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 KLOTZ RD
BOWLING GREEN OH
43402-4820
US

IV. Provider business mailing address

3445 SWAN RIDGE LN
MAUMEE OH
43537-9413
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-7588
  • Fax: 419-354-4977
Mailing address:
  • Phone: 419-491-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0008147
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1800918
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: