Individual
CONNIE BURNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
375 PARK AVE, COOS BAY, OR 97420-2244
(406) 925-1313
Mailing address
73495 HIGHWAY 101, NORTH BEND, OR 97459-7800
(406) 925-1313
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1158
MT
101YP2500X
Professional Counselor
Primary
C4806
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000741910
BLUE CROSS BLUE SHIELD
MT
05
—
0255374
—
MT
05
—
256542
—
MT
Enumeration date
12/28/2006
Last updated
07/30/2021
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