Provider Demographics
NPI:1699845008
Name:BURBANK, PATRICIA MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARIE
Last Name:BURBANK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:BYSON
Other - Last Name:BURBANK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:238 STEVES SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:HORTON
Mailing Address - State:MI
Mailing Address - Zip Code:49246-9742
Mailing Address - Country:US
Mailing Address - Phone:517-937-9321
Mailing Address - Fax:517-688-9874
Practice Address - Street 1:432 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1148
Practice Address - Country:US
Practice Address - Phone:517-937-9321
Practice Address - Fax:517-688-9874
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-00259101YA0400X
MI6401006102101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional