MEDICARE: MS. AMBER MERCEDES BURLEY PC

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	C 1000328	OH

General Provider Information

NPI Number	:	1487912788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMBER MERCEDES BURLEY PC

Provider Business Mailing Address
First Line	:	1494 OTTERCREEK DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-2858
Country	:	US
Telephone Number	:	513-313-4639
Fax Number	:

Provider Business Practice Location Address
First Line	:	1494 OTTERCREEK DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-2858
Country	:	US
Telephone Number	:	513-313-4639
Fax Number	:

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

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	04/25/2012

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