Healthcare Provider Details

I. General information

NPI: 1407695968
Provider Name (Legal Business Name): ELIZABETH BURENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 MADISON AVE STE 205
LAKEWOOD OH
44107-5097
US

IV. Provider business mailing address

12501 MADISON AVE STE 205
LAKEWOOD OH
44107-5097
US

V. Phone/Fax

Practice location:
  • Phone: 216-770-5508
  • Fax:
Mailing address:
  • Phone: 216-770-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2507075
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: