=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962980250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BURNS & FORTES CONSULTING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2018
-----------------------------------------------------
Last Update Date | 07/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 SPRING ST UNIT 209
-----------------------------------------------------
City | NEW BEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02740-5951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-991-3105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 SPRING ST UNIT 209
-----------------------------------------------------
City | NEW BEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02740-5951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-991-3105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, LADC
-----------------------------------------------------
Name | THOMAS J BURNS JR.
-----------------------------------------------------
Credential | LADC, CADC
-----------------------------------------------------
Telephone | 508-991-3105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 10381
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------