Individual
TIMOTHY BURNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
BROOKE ARMY MEDICAL CENTER, 3551 ROGER BROOKE DRIVE, FORT SAM HOUSTON, TX 78234
(801) 739-3873
Mailing address
1513 S 1220 W, WOODS CROSS, UT 84087-2370
(801) 739-3873
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
PY60675544
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2011
Last updated
10/07/2024
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