Provider Demographics
NPI:1225710239
Name:BURDEN, ADRIAN PATIQUE
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:PATIQUE
Last Name:BURDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-6748
Mailing Address - Country:US
Mailing Address - Phone:334-275-5210
Mailing Address - Fax:
Practice Address - Street 1:2741 BEAUMONT DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-6748
Practice Address - Country:US
Practice Address - Phone:334-275-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004537A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health