MEDICARE: MS. LAUREL IANNE BURNETT NCC, LMHC

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	101YM0800X	Mental Health Counselor	0122271	NM

General Provider Information

NPI Number	:	1346568300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREL IANNE BURNETT NCC, LMHC

Provider Business Mailing Address
First Line	:	PO BOX 51561
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87181-1561
Country	:	US
Telephone Number	:	505-503-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 LOUISIANA BLVD NE
Second Line	:	SOUTH BUILDING, SUITE #260
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3532
Country	:	US
Telephone Number	:	505-974-0104
Fax Number	:

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

Provider Enumeration Date	:	05/14/2010
Last Update Date	:	05/14/2010

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