Provider Demographics
NPI:1629243910
Name:JAMES D BURNS, PHD
Entity Type:Organization
Organization Name:JAMES D BURNS, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:616-633-8887
Mailing Address - Street 1:3604 W LEVER RD
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-9101
Mailing Address - Country:US
Mailing Address - Phone:231-873-4545
Mailing Address - Fax:231-873-4557
Practice Address - Street 1:3604 W LEVER RD
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-9101
Practice Address - Country:US
Practice Address - Phone:231-873-4545
Practice Address - Fax:231-873-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007308103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty