Healthcare Provider Details

I. General information

NPI: 1194470492
Provider Name (Legal Business Name): JESSE BURNS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 WHITNEY AVE
MEMPHIS TN
38127-6662
US

IV. Provider business mailing address

2220 UNION AVE
MEMPHIS TN
38104-4315
US

V. Phone/Fax

Practice location:
  • Phone: 901-353-5440
  • Fax:
Mailing address:
  • Phone: 901-567-3554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13558
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9669
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: