Provider Demographics
NPI:1699485870
Name:BURSON, SEAN PAUL (LPC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PAUL
Last Name:BURSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 S OVERBLUFF CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-3469
Mailing Address - Country:US
Mailing Address - Phone:505-238-1403
Mailing Address - Fax:
Practice Address - Street 1:2012 S OVERBLUFF CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-3469
Practice Address - Country:US
Practice Address - Phone:505-238-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-8930101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health