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NPI Code Detail

MEDICARE: KRISTINA M BURNS LPCC-S, LICDC

MEDICARE: KRISTINA M BURNS LPCC-S, LICDC
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
1101YP2500XProfessional CounselorE.0800503OH
2101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.162000OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114293842
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA M BURNS LPCC-S, LICDC
Provider Business Mailing Address
First Line : 1770 CENTENARY RD
Second Line :
City : GALLIPOLIS
State : OH
Zip : 45631-8530
Country : US
Telephone Number : 740-645-3051
Fax Number :
Provider Business Practice Location Address
First Line : 700 PARK AVE
Second Line :
City : IRONTON
State : OH
Zip : 45638-1502
Country : US
Telephone Number : 740-532-1613
Fax Number : 740-532-1715
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2012
Last Update Date : 10/31/2022

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Directions to “ KRISTINA M BURNS LPCC-S, LICDC” Practice Location

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