Provider Demographics
NPI:1578766226
Name:BURNS, CHARLES (MS,LCPC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BURNS
Suffix:
Gender:M
Credentials:MS,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 LAFAYETTE CT
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-3753
Mailing Address - Country:US
Mailing Address - Phone:618-344-2977
Mailing Address - Fax:
Practice Address - Street 1:503 S PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1847
Practice Address - Country:US
Practice Address - Phone:618-664-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional