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General NPI Number Information
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NPI Number | 1649919358
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Entity Type | Individual
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Provider Name | CASEY GRANT BURNS BS
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Gender | Male
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 15 2ND ST NW
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City | BUFFALO
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State | MN
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Zip | 55313-1357
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Country | US
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Telephone | 507-246-6831
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Fax | 320-310-0983
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Provider Business Mailing Address
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Address Line | 1243 EDMONSON AVE APT 210
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City | MONTICELLO
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State | MN
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Zip | 55362
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Country | US
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Telephone | 904-401-4260
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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