Tracy Burnham, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10129124-3501 Issued in UT

Practice address

94 E Pages LN
Suite a
Centerville, UT 84014-2216

Phone

(801) 294-0578

NPI assigned

Nov 1, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2017 through Apr 1, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• LDS Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Renton, WA
  • NPI 1073726485
  NPD (past)

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

{
    "created_epoch": "1477958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477958400000",
    "number": "1386196830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94 E PAGES LN",
            "address_2": "SUITE A",
            "city": "CENTERVILLE",
            "state": "UT",
            "postal_code": "840142216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 E PAGES LN",
            "address_2": "SUITE A",
            "city": "CENTERVILLE",
            "state": "UT",
            "postal_code": "840142216",
            "telephone_number": "801-294-0578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNHAM",
        "first_name": "TRACY",
        "credential": "L.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-01",
        "last_updated": "2016-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "10129124-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marian Anne Bridenstine, RN, FNP
• Kevin Dee Broderick, LMFT
• Melanie Brown, L.C.S.W.
• Victoria Schild Brown, DBH, LCSW
• Hope Nicole Burgess, DDS
• Jaquelinne Canas-Rodriguez
• Centered Behavioral Health & Wellness PLLC
• Centerville Dental Group, LLP
• Centerville Medical Center, Inc.
• Timothy Champlin

• Clinical Social Worker in Centerville, UT
• Providers in Centerville, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.