Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | KY |
NPI | 1033878657 |
---|---|
Provider Name | Brianna Burns |
First Address | New Albany, IN 47150-3003 |
Second Address | Louisville, KY 40218-4271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2021 |
Last Update Date | 10/12/2021 |