Healthcare Provider Details

I. General information

NPI: 1578702510
Provider Name (Legal Business Name): LAURA CASEY BURNS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2009
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 MENTOR AVE
MENTOR OH
44060-6103
US

IV. Provider business mailing address

8701 MENTOR AVE
MENTOR OH
44060-6103
US

V. Phone/Fax

Practice location:
  • Phone: 440-266-0770
  • Fax: 440-266-0257
Mailing address:
  • Phone: 440-266-0770
  • Fax: 440-266-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6523
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0003397SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: