Provider Demographics
NPI:1588146831
Name:BURNS, BRITTANY RAE (MS, LLP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:RAE
Last Name:BURNS
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26422 WARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2922
Mailing Address - Country:US
Mailing Address - Phone:989-450-3105
Mailing Address - Fax:
Practice Address - Street 1:3135 S STATE ST STE 108
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1653
Practice Address - Country:US
Practice Address - Phone:734-369-3180
Practice Address - Fax:734-369-3136
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007593103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0087692211Medicaid