Healthcare Provider Details

I. General information

NPI: 1811122914
Provider Name (Legal Business Name): LYNN M BURSELL LCMHC, ED.D., ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MOUNTAIN RD
WESTFORD VT
05494-9759
US

IV. Provider business mailing address

150 MOUNTAIN RD
WESTFORD VT
05494-9759
US

V. Phone/Fax

Practice location:
  • Phone: 802-893-4176
  • Fax:
Mailing address:
  • Phone: 802-893-4176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0680000647
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: