Provider Demographics
NPI:1629388772
Name:BURNS, MICHAEL GENE (LPCC, BIP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GENE
Last Name:BURNS
Suffix:
Gender:M
Credentials:LPCC, BIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N MAIN ST # 304
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1877
Mailing Address - Country:US
Mailing Address - Phone:574-546-1900
Mailing Address - Fax:
Practice Address - Street 1:306 W MAIN ST STE 512
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-1840
Practice Address - Country:US
Practice Address - Phone:574-546-1900
Practice Address - Fax:574-546-1999
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170523101YM0800X
WV2505101YP2500X
KY1093101YP2500X
KY105712101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty