MEDICARE: VIVIAN BURNS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1144741810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN BURNS

Provider Business Mailing Address
First Line	:	3809 FROSTWOOD TER
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-2715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 S FRETZ AVE STE C
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-5570
Country	:	US
Telephone Number	:	405-726-9808
Fax Number	:

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

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	07/03/2017

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Directions to “ VIVIAN BURNS ” Practice Location

Language	Start Address	Practice Location

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