Provider Demographics
NPI:1518564772
Name:BURLIN, MICHELLE DEBOARH (JD, MA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DEBOARH
Last Name:BURLIN
Suffix:
Gender:F
Credentials:JD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 MENDENHALL BLVD
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8928
Mailing Address - Country:US
Mailing Address - Phone:907-209-5544
Mailing Address - Fax:
Practice Address - Street 1:3005 CLINTON DR UNIT A4
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7167
Practice Address - Country:US
Practice Address - Phone:907-796-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AK162348101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty