Provider Demographics
NPI:1487912788
Name:BURLEY, AMBER MERCEDES (PC)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:MERCEDES
Last Name:BURLEY
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1494 OTTERCREEK DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2858
Mailing Address - Country:US
Mailing Address - Phone:513-313-4639
Mailing Address - Fax:
Practice Address - Street 1:1494 OTTERCREEK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-2858
Practice Address - Country:US
Practice Address - Phone:513-313-4639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 1000328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health