=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205983533
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENTON LEROY BURNS PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2007
-----------------------------------------------------
Last Update Date | 12/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2225 BIRCH ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80207-3735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-393-0801
-----------------------------------------------------
Fax | 303-388-4175
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2225 BIRCH ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80207-3735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-393-0801
-----------------------------------------------------
Fax | 303-388-4175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 431
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------