Provider Demographics
NPI:1760537757
Name:BURNHAM WOODS COUNSELING NORTH INC
Entity Type:Organization
Organization Name:BURNHAM WOODS COUNSELING NORTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEDEA
Authorized Official - Middle Name:LAUREL
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:812-594-2868
Mailing Address - Street 1:1970 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-5758
Mailing Address - Country:US
Mailing Address - Phone:321-639-4484
Mailing Address - Fax:321-690-0848
Practice Address - Street 1:1977 HIGHWAY 250
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:IN
Practice Address - Zip Code:47040-9550
Practice Address - Country:US
Practice Address - Phone:812-594-2868
Practice Address - Fax:812-594-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041772A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN192640Medicare ID - Type Unspecified