MEDICARE: ALYSSA MICHELLE BURTNER PSYD, LCP

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	101YP2500X	Professional Counselor	178011734	IL
2	103TC0700X	Clinical Psychologist	071010012	IL

General Provider Information

NPI Number	:	1609313790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MICHELLE BURTNER PSYD, LCP

Provider Business Mailing Address
First Line	:	2500 W HIGGINS RD STE 1250
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-2051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 W HIGGINS RD STE 1250
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-2051
Country	:	US
Telephone Number	:	847-303-1880
Fax Number	:

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

Provider Enumeration Date	:	01/26/2017
Last Update Date	:	09/30/2024

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