Provider Demographics
NPI:1073992186
Name:BURNHAM, PAIGE (LCPC)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 EXPRESSWAY APT 7
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1448
Mailing Address - Country:US
Mailing Address - Phone:406-649-2311
Mailing Address - Fax:
Practice Address - Street 1:90 TIGER ST
Practice Address - Street 2:
Practice Address - City:SAINT REGIS
Practice Address - State:MT
Practice Address - Zip Code:59866-9757
Practice Address - Country:US
Practice Address - Phone:406-649-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-12073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health