Provider Demographics
NPI:1194756783
Name:BURNS, SEAN EDWARD (MA LLP)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:EDWARD
Last Name:BURNS
Suffix:
Gender:M
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BURTON ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4398
Mailing Address - Country:US
Mailing Address - Phone:616-706-9741
Mailing Address - Fax:616-285-6880
Practice Address - Street 1:3300 BURTON ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4398
Practice Address - Country:US
Practice Address - Phone:616-706-9741
Practice Address - Fax:616-285-6880
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010834103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist