Healthcare Provider Details

I. General information

NPI: 1457269441
Provider Name (Legal Business Name): MOLLY BURDETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 SOUTH AVE STE 7
YOUNGSTOWN OH
44512-6434
US

IV. Provider business mailing address

253 CHRISTIAN AVE
HUBBARD OH
44425-2011
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-3325
  • Fax:
Mailing address:
  • Phone: 330-207-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2607553
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: