Provider Demographics
NPI:1093047128
Name:BURNS, JOHN ROBERT (MBA, CSAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:BURNS
Suffix:
Gender:M
Credentials:MBA, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 MACKAY DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3230
Mailing Address - Country:US
Mailing Address - Phone:909-383-1073
Mailing Address - Fax:909-383-1456
Practice Address - Street 1:423 MACKAY DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3230
Practice Address - Country:US
Practice Address - Phone:909-383-1073
Practice Address - Fax:909-383-1456
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor