Provider Demographics
NPI:1215798616
Name:BURNS, MITCHELL ALAN (SW CANDIDATE)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:ALAN
Last Name:BURNS
Suffix:
Gender:
Credentials:SW CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 RAY OF HOPE LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-3503
Mailing Address - Country:US
Mailing Address - Phone:406-591-6852
Mailing Address - Fax:
Practice Address - Street 1:1619 RAY OF HOPE LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-3503
Practice Address - Country:US
Practice Address - Phone:406-591-6852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT51529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health