Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | C5009 | OR |
NPI | 1003118365 |
---|---|
Provider Name | Karen Burns |
First Address | Medford, OR 97504-4004 |
Second Address | Medford, OR 97501-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2010 |
Last Update Date | 26/08/2019 |