Healthcare Provider Details

I. General information

NPI: 1003397555
Provider Name (Legal Business Name): HARRISON BURNS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5284 S COMMERCE DR STE C134
MURRAY UT
84107
US

IV. Provider business mailing address

5284 S COMMERCE DR STE C134
MURRAY UT
84107-5360
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-4643
  • Fax: 801-266-4775
Mailing address:
  • Phone: 801-266-4643
  • Fax: 801-266-4775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12881894-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: