Provider Demographics
NPI:1851252100
Name:BURNS, MATTHEW (PPC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BURNS
Suffix:
Gender:M
Credentials:PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 PIONEER AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3024
Mailing Address - Country:US
Mailing Address - Phone:307-222-8213
Mailing Address - Fax:
Practice Address - Street 1:2622 PIONEER AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3024
Practice Address - Country:US
Practice Address - Phone:307-222-8213
Practice Address - Fax:307-248-5600
Is Sole Proprietor?:No
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health