Healthcare Provider Details

I. General information

NPI: 1811765415
Provider Name (Legal Business Name): JOHN BURNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BRIARCREST DR
BRYAN TX
77802-2529
US

IV. Provider business mailing address

1100 BRIARCREST DR
BRYAN TX
77802-2529
US

V. Phone/Fax

Practice location:
  • Phone: 979-229-7636
  • Fax:
Mailing address:
  • Phone: 979-229-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: