Provider Demographics
NPI:1316043078
Name:BURNS, JAMIE ROSE (LCP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ROSE
Last Name:BURNS
Suffix:
Gender:
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 CORNELL DR
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2346
Mailing Address - Country:US
Mailing Address - Phone:620-200-0764
Mailing Address - Fax:
Practice Address - Street 1:1600 N LORRAINE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-5670
Practice Address - Country:US
Practice Address - Phone:620-663-7595
Practice Address - Fax:620-728-2036
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS287103T00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS199998120AMedicaid