MEDICARE: GRACE BURNS LPMT, MT-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225A00000X	Music Therapist

General Provider Information

NPI Number	:	1104767789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE BURNS LPMT, MT-BC

Provider Business Mailing Address
First Line	:	820 FOREST AVE
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-3712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 FOREST AVE
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-3712
Country	:	US
Telephone Number	:	618-578-4477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ GRACE BURNS LPMT, MT-BC” Practice Location

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