Healthcare Provider Details

I. General information

NPI: 1740352509
Provider Name (Legal Business Name): ROCHELLE BURNS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELLEY BURNS MA

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26425 NE ALLEN ST SUITE 103A
DUVALL WA
98019-8612
US

IV. Provider business mailing address

PO BOX 1688
DUVALL WA
98019-1688
US

V. Phone/Fax

Practice location:
  • Phone: 425-844-2103
  • Fax: 425-788-3917
Mailing address:
  • Phone: 425-844-2103
  • Fax: 425-788-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00005879
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: