Healthcare Provider Details

I. General information

NPI: 1033936554
Provider Name (Legal Business Name): NICOLE BURDEN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 S MONA DR
OAK CREEK WI
53154-3033
US

IV. Provider business mailing address

8045 S MONA DR
OAK CREEK WI
53154-3033
US

V. Phone/Fax

Practice location:
  • Phone: 414-840-1583
  • Fax:
Mailing address:
  • Phone: 414-840-1583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE E BURDEN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 414-840-1583