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General NPI Number Information
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NPI Number | 1679705669
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Entity Type | Individual
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Provider Name | CRYSTAL DAWN BURNS PLPC
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Gender | Female
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 1800 MADISON 257
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City | FREDERICKTOWN
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State | MO
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Zip | 63645-8273
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Country | US
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Telephone | 573-783-4400
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Fax | 573-783-4409
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Provider Business Mailing Address
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Address Line | 734 HIGHWAY AA
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City | FARMINGTON
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State | MO
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Zip | 63640-7075
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Country | US
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Telephone | 573-701-0054
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Fax | 573-783-4409
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2009023308
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License Number State | MO
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