=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679840086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANET BURNS, LPC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2011
-----------------------------------------------------
Last Update Date | 11/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1230 BONHEUR DR
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63146-5202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-225-9719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1230 BONHEUR DR
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63146-5202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-225-9719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JANET BURNS
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 314-225-9719
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2004021901
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------