1548439615 NPI number — BAMBI AYLISHA BURNS BS PSYCHOLOGY MHPP

Table of content: BAMBI AYLISHA BURNS BS PSYCHOLOGY MHPP (NPI 1548439615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548439615 NPI number — BAMBI AYLISHA BURNS BS PSYCHOLOGY MHPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNS
Provider First Name:
BAMBI
Provider Middle Name:
AYLISHA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS PSYCHOLOGY MHPP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURNS
Provider Other First Name:
BB
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1548439615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2410 HIGHWAY 65 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC GEHEE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71654-9437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-222-3107
Provider Business Mailing Address Fax Number:
870-222-6741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
790 ROBERTS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71655-5723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-367-2461
Provider Business Practice Location Address Fax Number:
870-460-6133
Provider Enumeration Date:
02/22/2008

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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