Provider Demographics
NPI:1427115732
Name:BURCH, JUDITH LYNNE (MS LPCC)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LYNNE
Last Name:BURCH
Suffix:
Gender:F
Credentials:MS LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BUTLER TRL
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2908
Mailing Address - Country:US
Mailing Address - Phone:937-836-2774
Mailing Address - Fax:
Practice Address - Street 1:2600 FAR HILLS AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-1687
Practice Address - Country:US
Practice Address - Phone:937-296-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0001717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health