Provider Demographics
NPI:1215222880
Name:BURNS, STEPHANIE T (MED)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:T
Last Name:BURNS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-7195
Mailing Address - Country:US
Mailing Address - Phone:866-936-8559
Mailing Address - Fax:866-936-8559
Practice Address - Street 1:120 S WASHINGTON ST
Practice Address - Street 2:SUITE 209
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2840
Practice Address - Country:US
Practice Address - Phone:866-936-8559
Practice Address - Fax:866-936-8559
Is Sole Proprietor?:No
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0600611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional