Provider Demographics
NPI:1154475143
Name:BURNS, THEODORE JOHNATHON JR (PLMHP, PLADC)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:JOHNATHON
Last Name:BURNS
Suffix:JR
Gender:M
Credentials:PLMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8133 MATHEW PL
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6375
Mailing Address - Country:US
Mailing Address - Phone:402-437-8971
Mailing Address - Fax:402-437-8932
Practice Address - Street 1:1430 SOUTH ST STE 103
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-2467
Practice Address - Country:US
Practice Address - Phone:402-437-8971
Practice Address - Fax:402-437-8932
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health