Provider Demographics
NPI:1033863162
Name:BURBANK, JENIFER L (LPC)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:L
Last Name:BURBANK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N 7TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3304
Mailing Address - Country:US
Mailing Address - Phone:719-671-1036
Mailing Address - Fax:
Practice Address - Street 1:303 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3373
Practice Address - Country:US
Practice Address - Phone:719-416-5407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0020038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional