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General NPI Number Information
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NPI Number | 1497087563
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Entity Type | Individual
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Provider Name | EDWARD ROSS BURNS L.M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2010
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 921 E 86TH ST SUITE 210B
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-1859
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Country | US
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Telephone | 317-259-8965
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Fax |
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Provider Business Mailing Address
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Address Line | 921 E 86TH ST SUITE 210B
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-1859
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Country | US
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Telephone | 317-259-8965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001687A
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License Number State | IN
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