Doctor Name: | MARK BURNS |
NPI Number: | 1053507103 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC, MS, PHD |
License Number: | 326-125 |
Business Practice Address: | 4040 N Calhoun Rd Suite 200 Brookfield, WI - 530051336 |
Business Phone Number: | 2627818123 |
Business Fax Number: | 2624371300 |
Mailing Address: | 4040 N Calhoun Rd, Suite 200 BROOKFIELD |
State: | WI |
Postal Code: | 530051336 |
Phone Number: | 2627818123 |
Fax Number: | 4144343939 |
NPI Enumeration Date: | 09/22/2007 |
NPI Last Update Date: | 12/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 326-125 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |