Provider Demographics
NPI:1134817513
Name:BURT, CHASLYN (ALC)
Entity type:Individual
Prefix:
First Name:CHASLYN
Middle Name:
Last Name:BURT
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 MISTY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-1111
Mailing Address - Country:US
Mailing Address - Phone:616-570-1821
Mailing Address - Fax:
Practice Address - Street 1:236 GOODWIN CREST DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3702
Practice Address - Country:US
Practice Address - Phone:205-224-2087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04427101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor