Provider Demographics
NPI:1649919358
Name:BURNS, CASEY GRANT (BS)
Entity type:Individual
Prefix:MR
First Name:CASEY
Middle Name:GRANT
Last Name:BURNS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 EDMONSON AVE
Mailing Address - Street 2:APT 210
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362
Mailing Address - Country:US
Mailing Address - Phone:904-401-4260
Mailing Address - Fax:
Practice Address - Street 1:15 2ND ST NW
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1357
Practice Address - Country:US
Practice Address - Phone:507-246-6831
Practice Address - Fax:320-310-0983
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty