Individual
DIANE C BURROUGHS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LSCSW
Contact information
Practice address
3555 CRANSWOOD WAY, COLORADO SPRINGS, CO 80918-6339
(719) 650-0812
Mailing address
3555 CRANSWOOD WAY, COLORADO SPRINGS, CO 80918-6339
(719) 650-0812
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
1056
KS
1041C0700X
Clinical Social Worker
Primary
CSW00989646
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
451657851
FEIN
CO
Enumeration date
05/28/2014
Last updated
05/28/2014
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