Provider Demographics
NPI:1346792843
Name:BURNS, JACQUIN (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUIN
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 MERRILL DR
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4052
Mailing Address - Country:US
Mailing Address - Phone:575-799-3365
Mailing Address - Fax:575-763-0041
Practice Address - Street 1:122 COCHRAN AVE E BLDG 575
Practice Address - Street 2:
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103-5159
Practice Address - Country:US
Practice Address - Phone:575-268-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-092911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical