Provider Demographics
NPI:1083945752
Name:BURNS, GARY L (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:BURNS
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CUNNINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5417
Mailing Address - Country:US
Mailing Address - Phone:217-442-7826
Mailing Address - Fax:
Practice Address - Street 1:614 N GILBERT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3940
Practice Address - Country:US
Practice Address - Phone:217-442-8564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004023101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor