Provider Demographics
NPI:1518069640
Name:BURNS, CHRISTINE W (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:W
Last Name:BURNS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S 600 E STE 8C
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1989
Mailing Address - Country:US
Mailing Address - Phone:801-935-4177
Mailing Address - Fax:866-202-9200
Practice Address - Street 1:150 S 600 E STE 8C
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1989
Practice Address - Country:US
Practice Address - Phone:801-935-4177
Practice Address - Fax:866-202-9200
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114559-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist