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General NPI Number Information
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NPI Number | 1699845008
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Entity Type | Individual
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Provider Name | PATRICIA MARIE BURBANK LPC
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Gender | Female
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 432 WILDWOOD AVE
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City | JACKSON
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State | MI
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Zip | 49201-1148
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Country | US
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Telephone | 517-937-9321
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Fax | 517-688-9874
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Provider Business Mailing Address
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Address Line | 238 STEVES SCENIC DR
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City | HORTON
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State | MI
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Zip | 49246-9742
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Country | US
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Telephone | 517-937-9321
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Fax | 517-688-9874
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2-00259
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401006102
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401006102
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License Number State | MI
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