Provider Demographics
NPI:1477295459
Name:BURNOUT RELIEF, PLLC
Entity Type:Organization
Organization Name:BURNOUT RELIEF, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-855-9275
Mailing Address - Street 1:22725 GREATER MACK AVE STE B301
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2048
Mailing Address - Country:US
Mailing Address - Phone:734-855-9275
Mailing Address - Fax:
Practice Address - Street 1:1130 PARKER ST APT 116
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2680
Practice Address - Country:US
Practice Address - Phone:734-855-9275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty