Provider Demographics
NPI:1215567169
Name:BURNETT, FELICIA MARIE (MS, LPCC-S)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:MARIE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MS, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E. MARKET ST.
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1736
Mailing Address - Country:US
Mailing Address - Phone:419-305-7214
Mailing Address - Fax:567-890-7214
Practice Address - Street 1:401 E. MARKET ST.
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1736
Practice Address - Country:US
Practice Address - Phone:419-305-7214
Practice Address - Fax:567-890-7214
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2303829101YP2500X, 101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0410589Medicaid