Connie Burnett, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C4806 Issued in OR

Practice address

375 Park Ave
Coos Bay, OR 97420-2244

Phone

(406) 925-1313

NPI assigned

Dec 28, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627603200000",
    "number": "1154487882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73495 HIGHWAY 101",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974597800",
            "telephone_number": "406-925-1313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 PARK AVE",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202244",
            "telephone_number": "406-925-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNETT",
        "first_name": "CONNIE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-28",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MT",
            "license": "1158",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C4806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000741910",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256542",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0255374",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda L Bufton, M.D.
• Corinna Rae Bukovics, CD
• Alishia Mae Bullis
• Pam Marie Burbank, RN
• Michael J. Burke, D.C.
• Haley Buss, DPT
• Kaylin Bustarga, RN, CDCES
• Louise J Cackowski, L.P.C.
• Cal-Ore Life Flight LLC
• Jessica Callen

• Professional Counselor in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.