Provider Demographics
NPI:1568588655
Name:BURNS, KEVIN DALE
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DALE
Last Name:BURNS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12143 DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3227
Mailing Address - Country:US
Mailing Address - Phone:303-457-9701
Mailing Address - Fax:
Practice Address - Street 1:456 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-5126
Practice Address - Country:US
Practice Address - Phone:303-504-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health