Doctor Name: | MICHELLE BURBANK |
NPI Number: | 1013300797 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 34007535A |
Business Practice Address: | 1001 Edgewood Dr. Suite 1 Knox, IN - 46534 |
Business Phone Number: | 5747728321 |
Business Fax Number: | |
Mailing Address: | 1001 Edgewood Dr. Suite 1, KNOX |
State: | IN |
Postal Code: | 46534 |
Phone Number: | 5747728321 |
Fax Number: | |
NPI Enumeration Date: | 03/05/2015 |
NPI Last Update Date: | 05/10/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 34007535A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |