1518415074 NPI number — MRS. KAWANA LA'SHAYE BURNETT LCSW

Table of content: MRS. KAWANA LA'SHAYE BURNETT LCSW (NPI 1518415074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518415074 NPI number — MRS. KAWANA LA'SHAYE BURNETT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNETT
Provider First Name:
KAWANA
Provider Middle Name:
LA'SHAYE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUNTER
Provider Other First Name:
KAWANA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518415074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6101 N KEYSTONE AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46220-2499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-638-9767
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 MUNICIPAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FISHERS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-638-9767
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149.022600 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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