MEDICARE: KRISTIN LEE BURTAINE MA, LCPC

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

General Provider Information

NPI Number	:	1538477765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN LEE BURTAINE MA, LCPC

Provider Business Mailing Address
First Line	:	1715 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3019
Country	:	US
Telephone Number	:	616-633-0476
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3019
Country	:	US
Telephone Number	:	616-633-0476
Fax Number	:

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

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	01/11/2021

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