Provider Demographics
NPI:1629506944
Name:BURNINGHAM, SHAYLEE NICOLE (ACMHC, NCC)
Entity Type:Individual
Prefix:
First Name:SHAYLEE
Middle Name:NICOLE
Last Name:BURNINGHAM
Suffix:
Gender:F
Credentials:ACMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5759 S WEBER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-9745
Mailing Address - Country:US
Mailing Address - Phone:385-238-5701
Mailing Address - Fax:
Practice Address - Street 1:2727 N WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-2241
Practice Address - Country:US
Practice Address - Phone:385-238-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10228629-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health